Dialectical Behavior Therapy
(DBT)
Dialectical Behavior Therapy
(DBT) Manual
Table of Contents
SECTION 1
Orientation
SECTION 2
Mindfulness
13
SECTION 3
Distress Tolerance
33
SECTION 4
Middle Path
7
SECTION 5
Emotion Regulation
103
SECTION 6
Interpersonal Effectiveness
159
SECTION 7
Addendum
183
Not All Who Wander Are Lost…
3
%JBMFDUJDBM#FIBWJPS5IFSBQZ
%#5
0SJFOUBUJPO
3
What Is Dialectical Behavior Therapy (DBT)?
• DBT is an effective treatment for people who have difficulty controlling their
emotions and behaviors.
• DBT aims to replace problem behaviors with skillful behaviors.
• DBT skills help people experience a range of emotions without necessarily
acting on those emotions.
• DBT skills help teens & familiesnavigate relationships in their environment
(relationships/school/
peers).
• DBT helps people create a life worth living.
What Does “Dialectical” Mean?
Dialectical = two opposite ideas can be true at the same time, and when
considered together, can create a new truth and a new way of viewing the
situation. There is always more than one way to think about a situation.
4
Goals of Skills Training
Target Behavior
DBT Skill
Confusion About Yourself:
Mindfulness:
Feelings of emptiness, not knowing
what you feel or why you get upset;
trouble making or holding to decisions
Awareness to thoughts, emotions, &
urges; Without adding or subtracting
Impulsivity:
Distress Tolerance:
Acting without thinking it all the way
through; alcohol or drug use; anger
reactions; suicidal or self-destruction
Tolerating stress and not making it
worse; accepting reality as it is
Emotional Instability:
Emotional Regulation:
Fast, intense mood changes with little
control; steady, negative emotional
state; Extreme mood swings &
sensitivity
Control of emotions;
Reduce vulnerabilities;
Change negative emotions
Interpersonal Problems:
Interpersonal Effectiveness:
Difficulty keeping steady relationships,
getting what you want, or keeping
self-respect; efforts to avoid rejection
or feelings of abandonment
Deal with conflicts; increase selfrespect; get what you want; say no
assertively
All Or Nothing Thinking:
Walking The Middle Path:
Things are either good or bad, fair or
unfair; polarized thinking, feeling, or
acting; always wanting to be right
Be willing to negotiate; see all
perspectives; live in gray
PERSONAL GOALS:
Behaviors UPEFDSFBTF
Behaviors to Increase
1.
1.
2.
3.
2.
4.
4.
5.
5.
3.
5
Options for Solving Any Problem
When life presents you with problems, what are your options?
1. SOLVE THE PROBLEM
Change the situation . . . or avoid, leave, or get out of the situation for
good.
2. FEEL BETTER ABOUT THE PROBLEM
Change (or regulate) your emotional response to the problem.
3. TOLERATE THE PROBLEM
Accept and tolerate both the problem and your response to the problem.
4. STAY MISERABLE
Or possibly make it worse!
1. TO PROBLEM-SOLVE:
Use interpersonal effectiveness skills
Walking the Middle Path (from interpersonal effectiveness skills)
Use problem-solving skills (from emotion regulation skills)
2. TO FEEL BETTER ABOUT THE PROBLEM:
Use emotion regulation skills
3. TO TOLERATE THE PROBLEM:
Use distress tolerance and mindfulness skills
4. TO STAY MISERABLE:
Use no skills!
6
Pros and Cons of Using Skills
Due Date:
Name:
Week Starting:
Use this worksheet to figure out the advantages and disadvantages to you of using skills (i.e., acting
skillfully) to reach your goals. The idea here is to figure out what is the most effective way for you to
get what you want in life. Remember, this is about your goals, not someone else’s goals.
Describe the situation or problem:
Describe your goal in this situation:
Make a list of the Pros and Cons of practicing your skills in this situation.
Make another list of the Pros and Cons for not practicing your skills or of not practicing them
completely.
Check the facts to be sure that you are correct in your assessment of advantages and
disadvantages.
Write on the back if you need more space.
Not Practicing Skills
Practicing Skills
Not Practicing Skills
CONS
PROS
Practicing Skills
What did you decide to do in this situation?
Is this the best decision (in Wise Mind)?
7
Biosocial Theory
BIO:
A. There is a biological vulnerability to emotions
1. high sensitivity
2. high reactivity
3. slow return to baseline
plus
B. An inability to effectively regulate emotions.
TRANSACTING
WITH . . .
SOCIAL:
An invalidating environment communicates that what you are feeling, thinking, or doing doesn’t
make sense or is considered inaccurate or an overreaction. Environments include parents, teachers,
peers, therapists, coaches, and others. Sometimes there is a “poor fit” (e.g., temperament) between
the person and the environment.
The invalidating environment punishes or sometimes reinforces emotional displays and contributes
to the person’s suppression or escalation of emotions, and sometimes leaves the person feeling
confused and unable to trust one’s own emotional experiences (self-invalidation).
OVER TIME LEADS TO . . .
Multiple Problems
(Chronic Emotional Dysregulation)
8
Biosocial Theory
Why do I have so much trouble controlling
my emotions and my actions?
Emotional vulnerability is BIOLOGICAL:
It’s simply how some people are born.
‰‰
They are more sensitive to emotional stimuli; they can detect subtle
emotional information in the environment that others don’t even notice.
‰‰
They experience emotions much more often than others.
‰‰
Their emotions seem to hit for no reason, from out of the blue.
‰‰
They have more intense emotions.
‰‰
Their emotions hit like a ton of bricks.
‰‰
And their emotions are long-lasting.
Impulsivity also has a BIOLOGICAL basis:
Regulating action is harder for some than for others.
‰‰
They find it very hard to restrain impulsive behaviors.
‰‰
Often, without thinking, they do things that get them in trouble.
‰‰
Sometimes their behavior seems to come out of nowhere.
‰‰
They find it very hard to be effective.
‰‰
Their moods get in the way of organizing to achieve their goals.
‰‰
They cannot control behaviors linked to their moods.
9
An invalidating SOCIAL environment
can make it very hard to regulate emotions.
‰‰
An invalidating environment doesn’t seem to understand your emotions.
‰‰
It tells you your emotions are invalid, weird, wrong, or bad.
‰‰
It often ignores your emotional reactions and does nothing to help you.
‰‰
It may say things like “Don’t be such a baby!” “Quit your blubbering.” “Quit
being such a chicken and just solve the problem.” or “Normal people don’t
get this frustrated.”
‰‰
People who invalidate are OFTEN DOING THE BEST THEY CAN.
‰‰
They may not know how to validate or how important it is to validate, or
they may be afraid that if they validate your emotions, you will get more
emotional, not less.
‰‰
They may be under high stress or time pressure, or they may have too
few resources themselves.
‰‰
There may be just a poor fit between you and your social environment:
You may be a tulip in a rose garden.
An ineffective SOCIAL environment
is a big problem when you want
to learn to regulate emotions and actions.
‰‰
Your environment may reinforce out-of-control emotions and actions.
‰‰
If people give in when you get out of control, it will be hard for you to get in
control.
‰‰
If others command you to change, but don’t coach you on how to do this,
it will be hard to keep on trying to change.
It’s the TRANSACTIONS that count
between the person and the social environment.
‰‰
Biology and the social environment influence the person.
‰‰
The person reciprocates and influences his or her social environment.
‰‰
The social environment reciprocates and influences the person.
‰‰
And so on and on and on.
10
Guidelines for the Adolescent Skills Training Group
1. Information obtained during sessions (including the names of other group
members) must remain confidential.
2.
a i i a si
a.
ee
s
ames a
b.
a ee e
c.
ali a e ea
ea
e
d.
i e el f l
e.
e illi
ea
e a
i f ma i
eff
fi e ial
a i e s ills e
e a i
i i al fee
a e
i
a
ea
ee sessi
e a
s
ass me
e es a
e as e
el f m a e s
e as
3. People are not to discuss any risk behaviors with other group members outside
of sessions. Participants do not tempt others to engage in problem behaviors.
4. People may not act in a mean or disrespectful manner toward other group
members or leaders.
5. For teens in a comprehensive DBT program, each adolescent must be in
ongoing individual DBT therapy.
11
DBT Assumptions
1. People are doing the best they can. ll e
e es e a
2. People want to improve. e mm
im
e ei li es a
e a
le a a
a a e is i
i e
f all e
i
i
le is
ime a e
a
e
i
a
3. People need to do better, try harder, and be more motivated to change. e fa
a e le a e i
e es e a a
a
e e e e
es
mea
a ese i s a e e
s l e e
lem And trying harder and
being more motivated may not be needed if progress is steady and at a realistic rate
of improvement.
4. People may not have caused all of their own problems and they have to solve
them anyway. e le a e
a e ei
e a i al es ses a al e ei
e i me f
ei life
a e Parents and caregivers must assist in this task.
5. The lives of emotionally distressed teenagers and their families are painful as
they are currently being lived.
6. Teens and families must learn and practice new behaviors in all the different
situations in their lives (e.g., home, school, work, neighborhood). e e a i al
s ills a e
e a i e i
e si a i s e e e s ills a e ee e
s e
si a i
e e e s ills a e fi s lea e
7.
be a
a ses f
a ses a e
.
ba
l
e e s
ac
a i
s
a e ca ed. e e is a a se
em i s e e if e
se f
a e
a dc a
e ca e
be a
be e a
d
a d
.
i a
lami a e easie
if e a
ea e a e i
e
e a e
a e e ai s f e e s a a se
a e e a i sa
. There is no absolute truth. e
s e
a e
1 .
e
s a
le s e e ie es f
Teens and their families cannot fail in DBT.
12
is ela i e si a i
al a
MINDFULNESS
I’m noticing
the thought that ...
13
Mindfulness: Taking Hold of Your Mind
Being in control of your mind rather than letting your mind be in control of
you.
I’m noticing
the thought that ...
1. FULL AWARENESS (Opened Mind): Being aware of the present moment (e.g.,
thoughts, emotions, and physical sensations) without judgment and without
trying to change it.
2. ATTENTIONAL CONTROL (Focused Mind): Staying focused on one thing at a
time.
14
Mindfulness Definitions
WHAT IS MINDFULNESS?
• Intentionally living with awareness in the present moment;
to participate and be present to our own lives.
• Without judging or rejecting the moment;
• And, without attachment to the moment.
the present by clinging to the past or
grabbing for the future.
WHAT ARE MINDFULNESS SKILLS?
• Mindfulness skills are the specific behaviors to practice that, when put together, make up
mindfulness.
WHAT IS MINDFULNESS PRACTICE?
• Mindfulness and mindfulness skills can be practiced at any time, anywhere, while doing
anything. Intentionally paying attention to the moment, without judging it or holding on to it, is all
that is needed.
• Meditation is practicing mindfulness and mindfulness skills while sitting, standing, or lying
quietly for a predetermined period of time. When meditating we focus the mind (for example, we
focus on body sensations, emotions, thoughts, or our breath), or we open the mind (paying
attention to whatever comes into our awareness).
• Mindfulness movement also has many forms.
15
Mindfulness: Why Bother?
Being mindful can . . .
1. Give you more choices and more control over your behavior. It helps you
slow down and notice emotions, thoughts, and urges (i.e., increases
self-awareness), and helps you choose a behavior more thoughtfully,
rather than act impulsively and make situations worse.
2. Reduce your emotional suffering and increase your pleasure and sense
of well-being.
3. Help you make important decisions (and balance overly emotional or overly
logical decisions).
4. Help focus your attention (i.e., be in control of your mind rather than letting
your mind be in control of you) and therefore make you more effective and
productive.
5. Increase compassion for self and others.
6. Lessen your pain, tension, and stress, and in turn can even improve your health.
Practice, practice, practice
16
Three States of Mind
Reasonable
Mind
Wise
Mind
Emotional
Mind
Emotional Mind is “hot,” ruled by your feelings and urges.
When I am in Emotional Mind, I tend to:
Reasonable Mind is “cool,” ruled by thinking, facts, and logic.
When I am in Reasonable Mind, I tend to:
Wise Mind includes both reason and emotion; it is the wisdom within each person and the state
of mind to access to avoid acting impulsively and when you need to make an important
decision. (Wise mind helps us think more clearly in the presence of strong emotions.)
When I am in Wise Mind, I tend to:
17
Practice Exercise:
Observing Yourself in Each State of Mind
Due Date:
Reasonable
Mind
Wise
Mind
Emotional
Mind
Emotional Mind
One example of
thoughts, behaviors):
this week was (please describe your emotions,
Reasonable Mind
One example of
thoughts, behaviors):
this week was (please describe your emotions,
ise Mind
One example of
behaviors):
this week was (please describe your emotions, thoughts,
18
Ideas for Practicing Wise Mind
The mindfulness skills often require a lot of practice. As with any new skill, it is important to first
practice when you don’t need the skill. If you practice in easier situations, the skill will become
automatic, and you will have the skill when you need it. Practice with your eyes closed and with
your eyes open.
1. Stone flake on the lake. Imagine that you are by a clear blue lake on a beautiful sunny day.
Then imagine that you are a small flake of stone, flat and light. Imagine that you have been
tossed out onto the lake and are now gently, slowly, floating through the calm, clear blue
water to the lake’s smooth, sandy bottom.
• Notice what you see, what you feel as you float down, perhaps in slow circles, floating
toward the bottom. As you reach the bottom of the lake, settle your attention there within
yourself.
• Notice the serenity of the lake; become aware of the calmness and quiet deep within.
• As you reach the center of your self, settle your attention there.
2. Walking down the spiral stairs. Imagine that within you is a spiral staircase, winding down
to your very center. Starting at the top walk very slowly down the staircase, going deeper
and deeper within yourself.
• Notice the sensations. Rest by sitting on a step, or turn on lights on the way down if you
wish. Do not force yourself further than you want to go. Notice the quiet. As you reach the
center of your self, settle your attention there—perhaps in your gut or your abdomen.
3.‰
Breathing “Wise” in, “Mind” out. Breathing in, say to yourself, “Wise”; breathing out, say
“Mind.”
• Focus your entire attention on the word “wise,” then, focus it again entirely on the word
“mind.”
• Continue until you sense that you have settled into Wise Mind.
4. Asking Wise Mind a question. Breathing in, silently ask Wise Mind a question.
• Breathing out, listen for the answer.
• Listen, but do not give yourself the answer. Do not tell yourself the answer; listen for it.
• Continue asking on each in-breath for some time. If no answer comes, try again another
time.
19
5.‰
Asking is this Wise Mind? Breathing in, ask yourself, “Is this (action, thought, plan, etc.)
Wise Mind?”
• Breathing out, listen for the answer.
• Listen, but do not give yourself the answer. Do not tell yourself the answer; listen for it.
• Continue asking on each in-breath for some time. If no answer comes, try again another
time.
. Attending to your breath coming in and out, let your attention settle into your center.
• Breathing in completely, notice and follow the sensations of your breath coming in.
• Let your attention settle into your center, at the bottom of your breath, at your solar
plexus—or
• Let your attention settle in the center of your forehead, your “third eye,” at the top of your
breath.
• Keeping your attention at your center, exhale, breathing normally, maintaining attention.
• Settle into Wise Mind.
. ‰
Expanding awareness. Breathing in, focus your awareness on your center.
• Breathing out, stay aware of your center, but expand awareness to the space you are in
now.
• Continue on in the moment.
. ‰
Dropping into the pauses between inhaling and exhaling.
• Breathing in, notice the pause after inhaling (top of breath).
• Breathing out, notice the pause after exhaling (bottom of breath).
• At each pause, let yourself “fall into” the center space within the pause.
. ‰
Other Wise Mind practice ideas:
20
Mindfulness “What” Skills
Observe
• Wordless watching : Just notice the experience in the present moment.
• Observe both inside and outside yourself, using all of your five senses.
• Watch your thoughts and feelings come and go, as if they were on a conveyer belt.
• Have a “Teflon mind,” letting experiences come into your mind and slip right out (not
holding on).
• Don’t push away your thoughts and feelings. Just let them happen, even when they’re
painful.
• Note: we cannot observe another’s inner experience (“He’s upset.”)—only external features
(e.g., a tear rolling down a cheek) or our thoughts about another’s experience (“I observed
the thought ‘He’s upset.’ “).
Describe
• Put words on the experience : Label what you observe with words.
• For example: “I feel sad,” “My face feels hot,” “I feel my heart racing,” “I’m having the
thought that . . . ,” “I’m having an urge to. . . . ”
• Describe only what you observe without interpretations. Stick to the facts! Instead of “that
person has an attitude,” you could describe that person as “rolling her eyes, speaking with
a loud voice.”
Participate
• Throw yourself into the present moment fully (e.g., dancing, cleaning, taking a test, feeling
sad in the moment). Try not to worry about tomorrow or focus on yesterday.
• Become one with whatever you’re doing: Get into the zone.
• Fully experience the moment without being self-conscious.
• Experience even negative emotions fully to help your Wise Mind make a decision about
what to do (instead of acting impulsively).
21
Ideas for Practicing Observing
BY COMING BACK TO YOUR SENSES
Remember: Observing is bringing your mind back to the sensations of your body and mind.
Observe with your eyes:
1. ‰‰
Lie on the ground and watch the clouds in the sky.
2. ‰‰
Walking slowly, stopping somewhere with a view, notice flowers, trees, and nature itself.
3. ‰‰
Sit outside. Watch who and what go by in front of you, without following them with your
head or your eyes.
4. ‰‰
Notice the facial expression and movements of another person. Refrain from labeling the
person’s emotions, thoughts, or interests.
5. ‰‰
Notice just the eyes, lips, or hands of another person (or just one feature of an animal).
6. ‰‰
Pick up a leaf, a flower, or a pebble. Look at it closely, trying to see each detail.
7. ‰‰
Find something beautiful to look at, and spend a few minutes contemplating it.
8. Other:
Observe sounds:
9. ‰‰
Stop for a moment and just listen. Listen to the texture and shape of the sounds around
you. Listen to the silences between the sounds.
10. ‰‰
If someone is talking, listen to the pitch of the voice, to the smoothness or roughness of the
sounds, to the clarity or the mumbling of the speech, to the pauses between the words.
11. ‰‰
Listen to music, observing each note as it comes and the spaces between the notes. Try
breathing the sounds into your body and letting them flow out again on your out breath.
12. Other:
Observe smells around you:
13. ‰‰
Breathing in, notice any smells around you. Bring something close to your nose, and notice
the smells. Take it away, and then notice the smells again. Do they linger?
14. ‰‰
When eating, notice the aroma of the food; when cooking, notice the aroma of the spices or
other ingredients; when bathing, smell the soap or shampoo; when walking outside, notice
the aroma of the air; when near flowers, bend down and “smell the roses.”
15. Other:
Observe taste and the act of eating:
16. ‰‰
Putting something in your mouth, pay attention to the taste. Keep it in your mouth, and
notice all the taste sensations.
17. ‰‰
Lick a lollipop or something else. Notice just the sensation of taste.
18. ‰‰
Eat a meal, or even a part of a meal, paying attention to the taste of each mouthful.
19. Other:
Observe urges to do something:
When you are feeling an urge to do something impulsive,
20. ‰‰
“Urge-surf” by imagining that your urges are a surfboard and you are standing on the
board, riding the waves.
21. ‰‰
Notice any urge to avoid someone or something.
22. ‰‰
Scan your entire body, and notice the sensations. Where in the body is the urge?
23. ‰‰
When you are chewing your food, notice when you have the urge to swallow.
24. Other:
22
Observe sensations of touch on your skin:
25. ‰‰
Stroke your upper lip with your fingernail.
• Stop stroking, and notice how long it takes before you can’t sense your upper lip at all.
26. ‰‰
When walking, notice the sensations of walking—your feet hitting the ground and rising up
and down. Sometimes walk very slowly and notice. Sometimes walk very fast and notice.
27. ‰‰
When sitting, notice your thighs on the chair. Notice the curve of your knees and your back.
28. ‰‰
Pay attention to anything touching you.
• Try to feel your feet in your shoes, your body touching your clothes.
• Feel your arms touching a chair.
• Notice the sensations of your hands.
29. ‰‰
Touch something—the wall, a fabric, a table top, a pet, a piece of fruit, a person.
• Notice the texture of what you feel, notice the sensations on your skin.
• Try it again with another part of your body.
• Notice the sensations again.
30. ‰‰
Focus your attention on the sensations in your chest, your stomach, or your shoulders.
31. ‰‰
Focus your attention on the place in your body where you feel tight or tense.
32. ‰‰
Focus your attention on the space between your eyes.
33. Other:
Observe your breath: Breathe evenly and gently, focusing your attention on:
34. ‰‰
The movement of your stomach.
• As you begin to breathe in, allow your belly to rise in order to bring air into the lower half
of your lungs.
• As the upper halves of your lungs begin to fill with air, your chest begins to rise.
• As you breathe out, notice your belly, then notice your chest. Don’t tire yourself.
35. ‰‰
The pauses in your breathing.
• As you breathe in, notice the brief pause when your lungs have filled with air.
• As you breathe out, notice the brief pause when you have expelled all the air.
36. ‰‰
The sensations in your nose as you breathe in and as you breathe out.
• As you breathe, close your mouth and breathe in through your nose, noticing the
sensations traveling up and down your nostrils.
37. ‰‰
Your breath while walking slowly. Breathe normally.
• Determine the length of your breath—the exhalation and the inhalation—by the number
of your footsteps. Continue for a few minutes.
• Begin to lengthen your exhalation by one step. Do not force a longer inhalation. Let it be
natural.
• Watch your inhalation carefully to see whether there is a desire to lengthen it. Now
lengthen the exhalation by one more footstep.
• Watch to see whether the inhalation also lengthens by one step or not.
• Only lengthen the inhalation when you feel that it will be comfortable.
• After 20 breaths, return your breath to normal.
38. ‰‰
Your breath while listening to a piece of music.
• Breathe long, light, and even breaths.
• Follow your breath; be master of it, while remaining aware of the movement and
sentiments of the music.
• Do not get lost in the music, but continue to be master of your breath and yourself.
39. ‰‰
Your breath while listening to a friend’s words and your own replies. Continue as with music.
40. Other:
23
Observe thoughts coming in and out of your mind:
41. ‰‰
Notice thoughts as they come into your mind.
• Ask, “Where do thoughts come from?”
• Then watch them to see if you can see where they come into your mind.
42. ‰‰
As you notice thoughts in your mind, notice the pauses between each thought.
43. ‰‰
Imagine that your mind is the sky and that thoughts are clouds.
• Notice each thought-cloud as it drifts by, letting it drift in and out of your mind.
• Imagine thoughts as leaves on water flowing down a stream, as boats drifting by on the
lake, or as train cars rolling by you.
44. ‰‰
When worries go round and round in your mind, move your attention to the sensations
in your body (those most intense right now). Then, keeping your attention on your body
sensations, notice how long it takes for the worries to ooze away.
45. ‰‰
Step back from your mind, as if you are on top of a mountain and your mind is just a
boulder down below.
• Gaze at your mind, watching what thoughts come up when you are watching it.
• Come back into your mind before you stop.
46. ‰‰
Watch for the first two thoughts that come into your mind.
47. Other:
Imagine that your mind is a:
48. ‰‰
Conveyor belt, and that thoughts and feelings are coming down the belt.
• Put each thought or feeling in a box, and then put it on the conveyor belt and let it go by.
49. ‰‰
Conveyor belt, and that you are sorting thoughts and feelings as they come down the belt.
• Label the types of thoughts or feelings coming by (e.g., worry thoughts, thoughts about
my past, thoughts about my mother, planning-what-to-do thoughts, angry feeling, sad
feelings).
• Put them in boxes nearby for another time.
50. ‰‰
River, and that thoughts and feelings are boats going down the river.
• Imagine sitting on the grass, watching the boats go by.
• Describe or label each boat as it goes by.
• Try not to jump on the boat.
51. ‰‰
Railroad track, and that thoughts and feelings are train cars going by.
• Describe or label each as it goes by. Try not to jump on the train.
52. Other:
Observe by expanding awareness:
53. ‰‰
Breathing in, notice your breath. Then, keeping your breath in your awareness, on the
next breath notice your hands. Then, keeping both in your awareness, on the next breath
expand your awareness to sounds.
• Continue holding all three in awareness at the same time.
• Practice this awareness of threes at other times, selecting other things to be aware of.
54. ‰‰
Keeping your focus on what you are currently doing, gently expand your awareness to
include the space around you.
55. ‰‰
Go hug a tree, and feel the sensations of the embrace.
• Attend to the embrace of the sheets and blankets or comforters around you as you lie in
bed.
• Do this when you feel lonely and want to be loved or to love.
56. Other:
24
Open your mind to your senses:
57. ‰‰
Practice walking with your senses as wide open as you can make them.
• Notice what you hear, see, and feel.
• Notice what you feel when shifting your weight between each step.
• Notice your body experience as you turn.
58. ‰‰
For one mouthful in a meal, pause with a spoonful or forkful of food.
• Look at what you are going to eat, smell it, and listen to it. Then, when you are ready, put
it in your mouth.
• Note the taste, texture, temperature, and even the sound your teeth make in chewing your
mouthful slowly.
• Note the changes in its taste, texture, temperature, and sound as you chew it to
completion.
59. ‰‰
Focus your mind on paying attention to each sensation that comes into your mind.
• Attend to sensations of sight, smell, touch, hearing, and taste, or to the thoughts
generated by your brain.
• Notice sensations as they arise, and notice them as they fall away.
• Let your mind focus on each sensation as it arises.
• Notice each sensation with curiosity, allowing it to be. Examine the uniqueness of each
sensation.
60. ‰‰
Be here. Be in the present now.
• Take a moment to notice every sense you are aware of.
• To yourself, make a statement, about each sense: “I feel the chair; the chair feels me.”
“I hear the heater; the heater hears me.” “I see the wall; the wall sees me.” “I hear a
stomach growl; it hears me.”
61. ‰‰
When a feeling arises within you, notice it—saying, for example, “A feeling of sadness is
arising within me.”
62. ‰‰
When a thought arises within you, notice it—saying, for example, “The thought ‘It is hot in
here’ is arising within me.”
63. ‰‰
Take just a moment of your time, and practice “nothing-to-do” mind.
• Let yourself become completely aware of your present experience, noticing sensations
and the space around you.
64. ‰‰
Find a small object, one you can hold in your hand. Place it in front of you on a table or in
your lap. Observe it closely—first not moving it, and then picking it up and turning it over
and around, gazing at it from different angles and in different lights. Just notice shapes,
colors, sizes, and other characteristics that are visible.
• Then change your focus to your fingers and hands touching the object. Notice the
sensations of touching the object; notice the texture, temperature, and feel of the object.
• Put the object down. Close your eyes, and inhale and exhale deeply and slowly.
• Then, with beginner’s mind, open your eyes. With new vision, once again notice the
object. With beginner’s mind, open to feeling new textures and sensations, explore the
object with your fingers and hands.
• Put down the object, and once again focus your mind on inhaling and exhaling once.
65. Other:
25
Ideas for Practicing Describing
Practice describing what you see outside of yourself:
1. ‰‰
Lie on the ground and watch the clouds in the sky. Find and describe cloud patterns that
you see.
2. ‰‰
Sit on a bench on a busy street or at a park. Describe one thing about each person who
walks by you.
3. ‰‰
Find things in nature—a leaf, a drop of water, a pet or other animal. Describe each thing in
as much detail as you can.
4. ‰‰
Describe as accurately as you can what a person has just said to you. Check to see if you
are correct.
5. ‰‰
Describe a person’s face when the person seems angry, afraid, or sad. Notice and describe
the shape, movement, and placement of the forehead, eyebrows, and eyes; the lips and
mouth; the cheeks; and so on.
6. ‰‰
Describe what a person has done or is doing now. Be very specific. Avoid describing
intentions or outcomes of the behavior that you do not directly observe. Avoid judgmental
language.
7. Other:
Practice describing thoughts and feelings:
8. ‰‰
Describe your feelings as they arise within you: “A feeling of anger is arising within me.”
9. ‰‰
Describe your thoughts when you feel a strong emotion: “I feel X, and my thoughts are Y.”
10. ‰‰
Describe your feelings after someone else does or says something: “When you do X, I feel
Y.”
11. ‰‰
Describe thoughts, feelings, and what you observed others do: “When you do X, I feel Y,
and my thoughts are Z.” “When X occurs, I feel Y, and my thoughts are Z.”
12. ‰‰
Describe as many of your thoughts as you can while feeling a strong emotion.
13. Other:
Practice describing your breathing:
14. ‰‰
Each time you inhale and exhale, as you inhale, be aware that “I am inhaling, 1.” When you
exhale, be aware that “I am exhaling, 1.” Remember to breathe from the stomach. When
beginning the second inhalation, be aware that “I am inhaling, 2.” And, slowly exhaling, be
aware that “I am exhaling, 2.” Continue on up through 10. After you have reached 10, return
to 1. Whenever you lose count, return to 1.
15. ‰‰
Begin to inhale gently and normally (from the stomach), describing in your mind that “I
am inhaling normally.” Exhale in awareness, “I am exhaling normally.” Continue for three
breaths. On the fourth breath, extend the inhalation, describing in your mind that “I am
breathing in a long inhalation.” Exhale in awareness, “I am breathing out a long exhalation.”
Continue for three breaths.
16. ‰‰
Follow the entrance and exit of air. Say to yourself, “I am inhaling and following the
inhalation from its beginning to its end. I am exhaling and following the exhalation from its
beginning to its end.”
17. Other:
26
Ideas for Practicing Participating
Participate with awareness of connection to the universe:
1.‰
Focus your attention on where your body touches an object (floor or ground, air molecules,
a chair or armrest, your bed sheets and covers, your clothes, etc.). Try to see all the ways
you are connected to and accepted by that object. Consider the function of that object with
relation to you. That is, consider what the object does for you. Consider its kindness in
doing that. Experience the sensation of touching the object, and focus your entire attention
on that kindness until a sense of being connected or loved or cared for arises in your heart.
Examples: Focus your attention on your feet touching the ground. Consider the kindness of
the ground holding you up, providing a path for you to get to other things, not letting you fall
away from everything else. Focus your attention on your body touching the chair you sit in.
Consider how the chair accepts you totally, holds you up, supports your back, and keeps
you from falling down on the floor. Focus your attention on the sheets and covers on your
bed. Consider the touch of the sheets and covers holding you, surrounding and keeping
you warm and comfortable. Consider the walls in the room. They keep out the wind and the
cold and the rain. Think of how the walls are connected to you via the floor and the air in the
room. Experience your connection to the walls that provide you with a secure place to do
things. Go hug a tree. Think of how you and the tree are connected. Life is in you and in the
tree and both of you are warmed by the sun, held by the air and supported by the earth. Try
and experience the tree loving you by providing something to lean on, or by shading you.
2. Dance to music.
3. Sing along with music you are listening to.
4. Sing in the shower.
. Sing and dance while watching TV.
. Jump out of bed and dance, or sing before getting dressed.
. Go to a church that sings, and join in the singing.
. Play karaoke with friends or at a karaoke club or bar.
. Throw yourself into what another person is saying.
1 . Go running, focusing only on running.
11. Play a sport and throw yourself into playing.
12. Become the count of the breath, becoming only “one” when you count 1, becoming only
“two” when you count 2, and so on.
13. Become a word as you slowly say the word over and over and over.
14. Take a class in improvisational acting.
1 . Take a dance class.
1 . Other:
27
Mindfulness “How” Skills
Don’t Judge
• Notice but don’t evaluate as good or bad. Stick to the observable facts of the situation,
using only what is observed with your senses.
• Acknowledge the harmful and the helpful, but don’t judge it. For example, replace “He’s a
jerk” with “He walked away while we were talking.”
• You can’t go through life without making judgments; your goal is to catch and replace them
with descriptions so you have more control over your emotions.
• When you find yourself judging, don’t judge your judging.
Stay Focused
• One-mindfully: Focus your attention on only one thing in this moment. Slow yourself down
to accomplish this.
• Stop doing two things at once (the opposite of multitasking).
• Concentrate your mind: Let go of distractions and refocus your attention when it drifts,
again and again.
• Stay focused so that past, future, and current distractions don’t get in your way.
Do What Works
• Be effective: Focus on what works to achieve your goal.
• Don’t let emotions control your behavior; cut the cord between feeling and doing.
• Play by the rules (which may vary at home, school, work).
• Act as skillfully as you can to achieve your goals.
• Let go of negative feelings (e.g., vengeance and useless anger) and “shoulds” (e.g., “My
teacher should have. . . . ”) that can hurt you and make things worse.
28
Ideas for Practicing Nonjudgmentalness
Leaving out comparisons, judgments, and assumptions:
1.‰
Practice observing judgmental thoughts and statements, saying in your mind,
“A judgmental thought arose in my mind.”
2. Count judgmental thoughts and statements (by moving objects or pieces of paper from
one pocket to another, by clicking a sports counter, or by marking a piece of paper).
3. Replace judgmental thoughts and statements with nonjudgmental thoughts and statements.
Tips for replacing judgment by stating the facts:
1. Describe the facts of the event or situation—only what is observed with your senses.
2. Describe the consequences of the event. Keep to the facts.
3. Describe your own feelings in response to the facts (remember, emotions are not
judgments).
4.‰
Observe your judgmental facial expressions, postures, and voice tones (including
voice tones in your head).
Change judgmental expressions, postures, and voice tones.
Tell someone what you did today nonjudgmentally, or about an event that occurred. Stay
very concrete; only relate what you observed directly.
Write out a nonjudgmental description of an event that prompted an emotion.
Write out a nonjudgmental blow-by-blow account of a particularly important episode in your
day. Describe both what happened in your environment and what your thoughts, feelings,
and actions were. Leave out any analysis of why something happened, or why you thought,
felt, or acted as you did. Stick to the facts that you observed.
9. Imagine a person you are angry with. Bring to mind what the person has done that has
caused so much anger. Try to become that person, seeing life from that person’s point
of view. Imagine that person’s feelings, thoughts, fears, hopes, and wishes. Imagine that
person’s history and what has happened in his or her history. Imagine understanding that
person.
When judgmental, practice half-smiling and/or willing hands. (See
Other:
29
3)
Ideas for Practicing One-Mindfulness
1. Awareness while making tea or coffee. Prepare a pot of tea or coffee to serve a guest or
to drink by yourself. Do each movement slowly, in awareness. Do not let one detail of your
movements go by without being aware of it. Know that your hand lifts the pot by its handle.
Know that you are pouring the fragrant, warm tea or coffee into the cup. Follow each step
in awareness. Breathe gently and more deeply than usual. Take hold of your breath if your
mind strays.
2. Awareness while washing the dishes. Wash the dishes consciously, as though each bowl
is an object of contemplation. Consider each bowl sacred. Follow your breath to prevent your
mind from straying. Do not try to hurry to get the job over with. Consider washing the dishes
the most important thing in life.
3. Awareness while hand-washing clothes. Do not wash too many clothes at one time.
Select only three or four articles of clothing. Find the most comfortable position to sit or
stand, so as to prevent a backache. Scrub the clothes consciously. Hold your attention on
every movement of your hands and arms. Pay attention to the soap and water. When you
have finished scrubbing and rinsing, your mind and body will feel as clean and fresh as your
clothes. Remember to maintain a half-smile and take hold of your breath whenever your
mind wanders.
4.‰
Awareness while cleaning house. Divide your work into stages: straightening things and
putting away books, scrubbing the toilet, scrubbing the bathroom, sweeping the floors, and
dusting. Allow a good length of time for each task. Move slowly, three times more slowly
than usual. Focus your attention fully on each task. For example, while placing a book on
the shelf, look at the book; be aware of what book it is; know that you are in the process
of placing it on the shelf; and know that you intend to put it in that specific place. Know
that your hand reaches for the book and picks it up. Avoid any abrupt or harsh movement.
Maintain awareness of the breath, especially when your thoughts wander.
5.‰
Awareness while taking a slow-motion bath. Allow yourself 30–45 minutes to take a
bath. Don’t hurry for even a second. From the moment you prepare the bath water to the
moment you put on clean clothes, let every motion be light and slow. Be attentive of every
movement. Place your attention on every part of your body, without discrimination or fear. Be
aware of each stream of water on your body. By the time you’ve finished, your mind will feel
as peaceful and light as your body. Follow your breath. Think of yourself as being in a clean
and fragrant lotus pond in the summer.
6.‰
Awareness with meditation. Sit comfortably on the floor with your back straight, on the
floor or in a chair with both feet touching the floor. Close your eyes all the way, or open them
slightly and gaze at something near. With each breath, say to yourself, quietly and gently,
the word “One.” As you inhale, say the word “One.” As you exhale, say the word “One,”
calmly and slowly. Try to collect your whole mind and put it into this one word. When your
mind strays, return gently to saying “One.” If you start wanting to move, try not to move. Just
gently observe wanting to move. Continue practicing a little past wanting to stop. Just gently
observe wanting to stop.
7. Other:
Note. Adapted from The Miracle of Mindfulness (pp. 84–87) by Thich Nhat Hanh. Copyright 1975, 1976 by Thich Nhat Hanh. Preface and English translation copyright 1975, 1976, 1987 by Mobi Ho. Adapted by permission of Beacon Press, Boston.
30
Ideas for Practicing Effectiveness
1.‰
Observe when you begin to get angry or hostile with someone. Ask yourself, “Is this
effective?”
2.‰
Observe yourself when you start wanting to be “right” instead of effective. Give up being
“right” and switch to trying to be effective.
3.‰
Notice willfulness in yourself. Ask yourself, “Is this effective?”
4.‰
Drop willfulness, and practice acting effectively instead. Notice the difference.
5.‰
When feeling angry or hostile or like you're about to do something ineffective, practice willing
hands.
6. Other:
31
Mindfulness Cheat Sheet
1. Identify what you will focus on:
Examples: Your breath
An object (a picture, burning candle)
An activity (brushing your hair, cleaning your room, reading)
2. Bring your attention to the object of focus.
3. When your attention wanders away from the object
of focus (and sometimes it will, so don’t judge
yourself for it!) . . .
• Notice that this has happened.
• Gently bring your attention back to the object
of focus.
To Get Started
Begin practicing mindfulness by noticing your attention
and how it wanders. Gradually work on doing this
practice for 30 seconds, 1 minute and 2 minutes at a
time. Practice a lot. No one will know you are doing it!
Your attention may wander to noises around you, worry thoughts, judgmental
thoughts such as “this is stupid,” body sensations, urges to talk, and so on). Notice
them, let them go, and return your attention to the object of focus.
32
DISTRESS TOLERANCE
33
Goals of Distress Tolerance
When to Use Crisis Survival Skills
e
e si a i
is
.
.
.
e
.
.
.
.
f
.
.
.
Why Bother Tolerating Painful Feelings and Urges?
Because . . .
.
.
.
34
STOP Skill
S
T
top
ake a step back
O
P
Do not just react. Stop! Freeze! Do not move a muscle! Your
emotions may try to make you act without thinking. Stay in control!
Take a step back from the situation. Take a break. Let go. Take a
deep breath. Do not let your feelings make you act impulsively.
bserve
Notice what is going on inside and outside you. What is the
situation? What are your thoughts and feelings? What are others
saying or doing?
roceed mindfully
Act with awareness. In deciding what to do, consider your
thoughts and feelings, the situation, and other people’s thoughts
and feelings. Think about your goals. Ask Wise Mind: Which
actions will make it better or worse?
35
Crisis Survival Skills:
Distract with “Wise Mind ACCEPTS”
Activities
Do something. Call, e-mail, text, or visit a friend;watch a favorite
movie or TV show; play your instrument or sing; play videogames;
draw, cook, or bake; write in a journal; clean your room; go for a
walk or exercise; read a book; listen to your iPod, go online and
download music, apps; play a game with yourself or others.
Contributing
Contribute to (do something nice for) someone. Help a friend
or sibling with homework; make something nice for someone
else; donate things you don’t need; surprise someone with a hug,
a note, or a favor; volunteer.
Comparisons
Compare yourself to those less fortunate. Compare how you are
feeling now to a time when you were doing worse. Think about
others who are coping the same or less well than you.
Emotions
Create different emotions. Watch a funny TV show or
emotional movie; listen to soothing or upbeat music; get active
when you are sad; go to a store and read funny greeting cards
or joke books. a e es s
s
a s i s me e
Pushing away Push the painful situation out of your mind temporarily. Leave
the situation mentally by moving your attention and thoughts
away; build an imaginary wall between you and the situation. Put
the pain in a box and on a shelf for a while.
Thoughts
Replace your thoughts. Read; do word or number puzzles;
count numbers, colors in a poster, tiles on a wall, anything;
repeat the words to a song in your mind.
Sensations
Intensify other sensations. Hold or chew ice; listen to loud
music; take a warm or cold shower; squeeze a stress ball; do situps and push-ups; pet your dog or cat.
36
Crisis Survival Skills: Self-Soothe with Six Senses
VISION
HEARING
SMELL
TASTE
TOUCH
MOVEMENT
Vision
Go to your favorite place and take in all the sights; look at a photo album; zone
out to a poster/picture; notice colors in a sunset; people watch.
Hearing
Listen to your favorite music and play it over and over again; pay attention to
sounds in nature (birds, rain, thunder, traffic s
sa
); play an
instrument or sing; listen to a sound machine.
Smell
Put on your favorite lotion; use a scented aftershave or body wash; make
cookies or popcorn; smell freshly brewed coffee; go to the park and “smell the
roses.”
Taste
Eat some of your favorite foods; drink your favorite nonalcoholic beverage;
have your favorite flavor of ice cream; really notice the food you eat; eat one
thing mindfully; don’t overdo it!
Touch
Take a bath or shower; pet your dog or cat; get a massage; brush your hair;
hug or be hugged; put a cold cloth on your head; change into your most
comfortable clothes.
Movement
Rock yourself gently; stretch; go for a run; do yoga; e e ise dance!
37
Crisis Survival Skills: IMPROVE the Moment
IMPROVE the Moment with:
Imagery
Imagine very relaxing scenes of a calming, safe place. Imagine things
going well; imagine coping well. Imagine painful emotions draining out of
you like water out of a pipe.
Meaning
Find or create some purpose, meaning, or value in the pain. Make
lemonade out of lemons.
Prayer
Open your heart to a supreme being, greater wisdom, or your own Wise
Mind. Ask for strength to bear the pain in this moment.
Relaxation
Try to relax your muscles by tensing and relaxing each large muscle group,
starting with the forehead and working down. Download a relaxation
audio or video; stretch; take a bath or get a massage.
One thing in
the Moment
Focus your entire attention on what you are doing right now. Keep your
mind in the present moment. Be aware of body movements or sensations
while you’re walking, cleaning, eating.
Vacation
Give yourself a brief vacation.
Get outside, take a short walk,
go get your favorite coffee drink
or smoothie, read a
or
ma a i e; surf the web; take a
1-hour breather from hard work
that must be done. Unplug from
all electronic devices.
Encouragement Cheerlead yourself. Repeat over
and over: “I can stand it,” “It
won’t last forever,” “I will make it
out of this,” I’m doing the best I
can.”
38
Body Scan Meditation Step by Step
Sit on a chair, or lie on your back on the floor with legs uncrossed. Put your arms in a comfortable
position by your side, on your abdomen, or (if sitting) put them on your thighs palms up. Open your
eyes partially to let light in. If you are lying on the floor, put a cushion under your knees if need
be. Imagine your breath flowing to each part of your body as your attention gently moves up your
body. Adopt a mind of curiosity and interest as you focus on each part of your body.
Focus on your breathing. Notice how the air moves in and out of your body.
•
•
•
•
•
•
Take several deep breaths until you begin to feel comfortable and relaxed.
Direct your attention to the toes of your left foot.
Notice the sensations in that part of your body while remaining aware of your breathing.
Imagine each breath flowing to your toes.
Looking with curiosity, ask, “What am I feeling in this part of my body?”
Focus on your left toes for several minutes.
• Then move your focus to the arch and heel of your left foot, and hold it there for a minute or
two while continuing to pay attention to your breathing.
• Notice the sensations on your skin of warmth or coldness; notice the weight of your foot on
the floor.
• Imagine your breath flowing to the arch and heel of your left foot.
• Ask, “What are the feelings in the arch and heel of my left foot?”
•
•
•
•
•
Follow the same procedure as you move to your left ankle, calf, knee, upper legs, and thigh.
Repeat with the right leg, starting with your toes.
Then move through your pelvis, and lower back, and around to your stomach.
Focus on the rising and falling of your belly as your breath goes in and out.
Then go on to your chest; left hand, arm, and shoulder; right hand, arm, and shoulder; neck,
chin, tongue, mouth, lips, and lower face; and nose.
• Notice your breath as it comes in and out of your nostrils.
• Then focus on your upper cheeks, eyes, forehead, and scalp.
• Finally, focus on the very top of your hair.
• Then let go of your body altogether.
Don’t worry if you notice that thoughts, sounds, or other sensations come into your awareness.
Just notice them and then gently refocus your mind. Don’t worry if your mind has been drawn away
from the object of your attention and you find yourself thinking about something else (it nearly
always happens). Just calmly, gently, but with resolution, turn your mind back to the part of the body
you’ve reached. You may need to bring your attention back over and over. You are not alone in this.
It is this bringing of your attention back over and over and over, without judgment or harshness, that
is the essential element of the meditation.
39
Crisis Survival Skills: Pros and Cons
Select one crisis (emotionally upsetting situation) where you find it really hard to tolerate your
distress, avoid destructive behavior, and not act impulsively.
Crisis I am faced with:
Crisis urges:
• An urge can intensify a crisis when it is intense and acting on the urge will make things
worse in the long term.
• Make a list of the pros and cons of acting on your crisis urges. These might be to engage
in addictive or harmful behavior or it might be to give in, give up, or avoid doing what is
necessary to build a life you want to live.
• Make another list of the pros and cons of resisting crisis urges—that is, tolerating the
distress skillfully and not giving into the urge.
40
Crisis Survival Skills: Pros and Cons
PROS
CONS
Acting on
Pros of acting on impulsive urges:
Crisis Urges
Cons of acting on impulsive urges:
Resisting
Pros of resisting impulsive urges:
Crisis Urges
Cons of resisting impulsive urges:
1. Consider short-term and long-term PROS and CONS.
2. Before an overwhelming urge hits:
Write out your PROS and CONS and carry them with you.
3. When an overwhelming urge hits:
Review your PROS and CONS and imagine the positive consequences of resisting the urge.
Imagine (and remember past) negative consequences of giving in to crisis urges.
41
i
n
o
otiona a o
i i
i a
anaging
a i
t
i
otion
y
.
.
.
p at
ip t t p at
ca down a t.
o yo
ac wit co d wat
to
.
.
3
.
a tion
.
.
.
.
nt n
ci
o ca
down yo
ody w
n it i
d p y
1
1
otion.
.
. Don’t
ac d
at ing
ow yo
.
pac o
at ing way down
.
n
. . 4
o t
.
1 2
.
og
n
i
and
c
a
a ation
ac
c
go p
.
. ot
.
42
not
n
Using Cold Water, Step by Step
COLD WATER CAN WORK WONDERS*
When you put your full face into cold water . . . or you put a zip-lock bag
with cold water on your eyes and upper cheeks, and hold your breath, it
tells your brain you are diving underwater.
This causes the “dive response” to occur. (It may take 15–30 seconds to
start.)
Your heart slows down, blood flow to nonessential organs is reduced, and
blood flow is redirected to the brain and heart.
This response can actually help regulate your emotions.
This will be useful as a distress tolerance strategy when you are having
a very strong, distressing emotion, or when you are having very strong
urges to engage in dangerous behaviors.
(This strategy works best when you are sitting quietly—activity and
distraction may make it less effective.)
TRY IT OUT!
*Caution: Very cold water decreases your heart rate. If you have any heart or medical condition, have a lowered base heart rate due to medications, or are on a beta-blocker, consult your health care provider before using these skills. Avoid ice water if you are allergic to the cold.
43
Paired Muscle Relaxation, Step by Step
If you have decided to practice paired muscle relaxation, it can be very helpful to practice
relaxing each of your muscles first.
When you are starting, practice in a quiet place to reduce distractions, and make sure that you
have enough time. As you improve with practice, you will want to practice in many different kinds of
places, so that you can relax effectively when you most need to.
Remember that effectiveness improves with practice. If judgments arise, observe them, let
them go, and return to your practice. If you become anxious, try focusing on breathing in to the
count of 5 and out to the count of 7 (or the counts you have already determined for paced breathing),
breathing all the while into your belly until you can return to relaxation exercises.
Now that you are ready to begin . . .
1. Get your body into a comfortable position in which you can relax. Loosen tight clothing. Lie or
sit down, with all body parts uncrossed and no body part supporting any others.
2. For each area of the body listed below, gather tension by tightening muscles. Focus on the
sensation of tightness in and around that area. Hold the tension as you inhale for 5–6 seconds,
then release and breathe out.
3. As you release, say in your mind very slowly the word “Relax.”
4. Observe the changes in sensations as you relax for 10–15 seconds then move on to the next
muscle.
Start first with each of the 16 muscle groups.
Once you can do that, practice with medium groups of muscles and then large groups.
Once you are good at that, practice tensing your entire body at once.
Large
Medium
Small
When you tense your entire body, you are like a robot—stiff, nothing moving.
When you relax your entire body, you are like a rag doll—all muscles drooping down.
⎧
⎪
⎨
⎪
⎩
⎧
⎪
⎪
⎨
⎪
⎪
⎩
⎧
⎪
⎨
⎪
⎩
⎧
⎪
⎪
⎨
⎪
⎪
⎩
⎧
⎨
⎩
⎧
⎪
⎨
⎪
⎩
⎧
⎨
⎩
⎧
⎨
⎩
⎧
⎨
⎩
⎧
⎪
⎨
⎪
⎩
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Once you can relax all your muscles, practice three or four times a day until you can routinely
relax your entire body rapidly.
By practicing pairing exhaling and the word “Relax” with relaxing your muscles, you will
eventually be able to relax just by letting go and saying the word “Relax.”
Hands and wrists: Make fists with both hands and pull fists up on the wrists.
Lower and upper arms: Make fists and bend both arms up to touch your shoulders.
Shoulders: Pull both shoulders up to your ears.
Forehead: Pull eyebrows close together, wrinkling forehead.
Eyes: Shut eyes tightly.
Nose and upper cheeks: Scrunch up nose; bring upper lips and cheeks up toward eyes.
Lips and lower face: Press lips together; bring edges of lips back toward ears.
Tongue and mouth: Teeth together; tongue pushing on upper mouth.
Neck: Push head back into chair, floor, or bed, or push chin down to chest.
Chest: Take deep breath and hold it.
Back: Arch back, bringing shoulder blades together.
Stomach: Hold stomach in tightly.
Buttocks: Squeeze buttocks together.
Upper legs and thighs: Legs out; tense thighs.
Calves: Legs out; point toes down.
Ankles: Legs out; point toes together, heels out, toes curled under.
Remember, paired relaxation is a skill. It takes time to develop. With practice, you will notice the benefits.
44
Effective Rethinking and Paired Relaxation,
Step by Step
Stressful
prompting event
What I tell myself
Emotional arousal
Step 1. Write down the prompting event that is often related to distressing emotions and that you
want to work on reducing your emotional reactions to.
Step 2. Ask: “What must I be telling myself (that is, what are my interpretations and thoughts)
about the event that causes such distress and arousal?” Write these down. Examples:
“He hates me,” “I can’t stand this!” “I can’t do this,” “I’ll never make it,” “I’m out of control!”
Step 3. Rethink the situation and its meaning in a way that counteracts the thoughts and interpretations producing stress and distressing emotions. As you rethink the situation, write down as many
effective thoughts as you can to replace the stressful thoughts.
Step 4. When you are not in the stressful prompting event, practice imagining the stressful event:
a. At the same time, while breathing in, say to yourself an effective self-statement.
b. When breathing out, say “Relax” while intentionally relaxing all your muscles.
Step 5. Keep practicing every chance you get until you have mastered the strategy.
Step 6. When a stressful situation occurs, practice effective rethinking and paired relaxation.
.)
at
..
st
in
lf-
g
se
at
h
in
tiv
e
(b
t)
ou
re
g
fe
c
in
th
.”
ea
ax
br
el
.r
..
Ef
..
(.
em
en
t.
..
“ . . . So . . .
Examples:
“It’s not that important . . . so . . . relax.
“I may not like this, but I can definitely stand
it . . . so . . . relax.”
“I need to concentrate and not make myself
uptight . . . so . . . relax.”
“I’m in control . . . so . . . relax.”
45
Effective Rethinking and Paired Relaxation
Due Date:
Name:
Week Starting:
Step 1. Describe one typical prompting event for distress in your life: What led up to what? What
is it about this event that is a problem for you? Be very specific in your answers. Use describing
skills. Check the facts.
Step 2. Ask: “What must I be telling myself (or what are my interpretations and thoughts)
about this event that contributes to my stress?” Write them down.
Step 3. Rethink the thoughts that lead to distress. Rethinking involves reevaluating the situation
and its meaning in ways that counteract stress-producing thoughts and thereby reduce stress
responses. Write down as many effective thoughts as you can to replace the stressful thoughts.
Step 4. Did you practice in your imagination effective rethinking of a stressful situation this
week? Yes
No
If you engaged in rethinking, did it reduce fear of the situation happening again? (0–5,
0 = not at all; 5 = very much):
What effective thoughts did you use to replace stress-causing thoughts?
Rate average level of relaxation (0–100): Before
After
Step 5. Did you practice rethinking plus paired relaxation? Yes
No
If you engaged in rethinking plus paired relaxation, did it help you reduce your stress? (0–5,
0 = not at all; 5 = very much):
What effective thoughts did you use to replace stress-causing thoughts?
Comments:
46
Create Your Crisis Survival Kit
for Home, School, or Work
List below 10 “tools” that go into your home crisis survival kit. Choose from your Distract with
Wise Mind ACCEPTS skills, your Self-Soothe skills, your IMPROVE skills, and your TIPP skills.
Take a shoebox, sturdy bag, or basket and place the relevant items inside: for example, your
iPod, a stress ball, your favorite scented lotion or aftershave, picture of your favorite vacation
spot, a favorite magazine, a crossword book, herbal tea bags, a favorite piece of candy, a
relaxation CD or DVD.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Create a smaller version of your kit for school or work that fits in a pencil case or lunchbox.
Consider items that can be used at your desk: for example, multicolored rubber bands to
stretch; paper and pens for doodling; a mini-pack of playdough; a squeeze ball; silly putty;
a list of visual stimuli in your class or office that can distract or soothe you; snacks to selfsoothe; a list of friends, teachers, counselors, or colleagues you can approach when you
have a break.
1.
2.
3.
4.
5.
6.
47
Sensory Awareness, Step by Step
Find a comfortable position. Staying in this position, listen to the questions below, listening for your
response after each question. If you do not have a recording of these questions, you can make
one for yourself (or ask a friend to make one), recording each question with about 5 seconds
between each question.
1. Can you feel your hair touching your head?
2. Can you feel your belly rising and falling as you breathe?
3. Can you feel the space between your eyes?
4. Can you feel the distance between your ears?
5. Can you feel your breath touching the back of your eyes while you inhale?
6. Can you picture something far away?
7. Can you notice your arms touching your body?
8. Can you feel the bottoms of your feet?
9. Can you imagine a beautiful day at the beach?
10. Can you notice the space within your mouth?
11. Can you notice the position of your tongue in your mouth?
12. Can you feel a breeze against your cheek?
13. Can you feel how one arm is heavier than the other?
14. Can you feel a tingling or numbness in one hand?
15. Can you feel how one arm is more relaxed than the other?
16. Can you feel a change in the temperature in the air around you?
17. Can you feel how your left arm is warmer than the right?
18. Can you imagine how it would feel to be a rag doll?
19. Can you notice any tightness in your left forearm?
20. Can you imagine something very pleasant?
21. Can you imagine what it would feel like to float on a cloud?
22. Can you imagine what it would feel like to be stuck in molasses?
23. Can you picture something far away?
24. Can you feel a heaviness in your legs?
25. Can you imagine floating in warm water?
26. Can you notice your body hanging on your bones?
27. Can you allow yourself to drift lazily?
28. Can you feel your face getting soft?
29. Can you imagine a beautiful flower?
30. Can you feel how one arm and leg are heavier than the other?
48
Accepting Reality: Choices We Can Make
Five optional ways of responding when a serious problem comes into your life:
1. Figure out how to solve the problem.
2. Change how you feel about the problem.
3. Accept it.
4. Stay miserable (no skill use).
5. Make things worse (act on your impulsive urges).
When you can’t solve the problem or change your emotions about the problem, try
acceptance as a way to reduce your suffering.
Why Bother Accepting Reality?
‰
Rejecting reality does not change reality.
‰
Changing reality requires first accepting reality.
‰
Rejecting reality turns pain into suffering.
‰
Refusing to accept reality can keep you stuck in unhappiness, anger, shame,
sadness, bitterness, or other painful emotions.
Radical Acceptance
‰
RADICAL ACCEPTANCE is the skill of accepting the things you can’t change.
‰
RADICAL = complete and total accepting in mind, heart, and body.
‰
ACCEPTANCE = seeing reality for what it is, even if you don’t like it.
‰
ACCEPTANCE can mean to acknowledge, recognize, endure, not give up or give
in.
‰
It’s when you stop fighting reality, stop throwing tantrums about reality, and let
go of bitterness. It is the opposite of “Why me?” It is “Things are as they are.”
‰
Life can be worth living, even with painful events in it.
49
Accepting Reality: Turning the Mind
‰
ACCEPTANCE is a choice. It is like coming to a “fork in the road.” You may have
to turn your mind toward the ACCEPTANCE road and away from the REJECTING
“Reality Road.”
‰
First notice you are not accepting reality (anger, bitterness, “Why me?”)
‰
Second, make an inner commitment to ACCEPT.
‰
You may have to turn your mind over and over and over again.
Factors That Interfere with Acceptance
‰
Beliefs get in the way: You believe that if you accept your painful situation, you
will become weak and just give up (or give in), approve of reality, or accept a
life of pain.
‰
Emotions get in the way: Intense anger at the person or group that caused
the painful event; unbearable sadness; guilt about your own behavior; shame
regarding something about you; rage about the injustice of the world.
REMEMBER: ACCEPTANCE DOES NOT MEAN APPROVAL!
Accepting
Reality
50
Willingness
WILLFULNESS IS . . .
• Willfulness is refusing to tolerate a situation or giving up.
• Willfulness is trying to change a situation that cannot be changed, or refusing to
change something that must be changed.
• Willfulness is “the terrible twos”—“no . . . no . . . no . . . ”
• Willfulness is the opposite of “DOING WHAT WORKS”
REPLACE WILLFULNESS WITH WILLINGNESS.
WILLINGNESS IS . . .
• allowing the world to be what it is and participating in it fully.
• doing just what is needed—no more, no less. It is being effective.
• listening carefully to your Wise Mind and deciding what to do.
• When willfulness doesn’t budge, ask: “What is the threat?”
How can you feel the difference between when you are willing and when you are
willful ? Clues that you are being willful: extreme thoughts like “No way!”; muscles
tightening.
51
Where were you willful?
How were you willful (e.g., thoughts, feelings, body sensations)?
What happened?
Where were you willing?
How were you willing (e.g., thoughts, feelings, body sensations)?
What happened?
52
Half-Smiling and Willing Hands
Accepting reality with your body.
HALF-SMILING
1st. Relax your face from the top of your head down to your chin and jaw.
Let go of each facial muscle (forehead, eyes, and brows; cheeks,
mouth, and tongue; teeth slightly apart). If you have difficulty, try
tensing your facial muscles and then letting go.
A tense smile is a grin (and might tell your brain you are hiding or
masking your real feelings).
2nd. Let both corners of your lips go slightly up, just so you can feel them.
It is not necessary for others to see it. A half-smile is slightly
upturned lips with a relaxed face.
3rd. Try to adopt a serene facial expression.
Remember, your face communicates to your brain; your body
connects to your mind.
WILLING HANDS
Standing:
Drop your arms down from your shoulders; keep them
straight or bent slightly at the elbows. With hands
unclenched, turn your hands outward, with thumbs out to
your sides, palms up, and fingers relaxed.
Sitting:
Place your hands on your lap or your thighs. With hands
unclenched, turn your hands outward, with palms up and
fingers relaxed.
Lying down:
Arms by your side, hands unclenched, turn your palms
up with fingers relaxed.
Remember, your hands communicate to your brain; your body connects to
your mind.
53
Practicing Half-Smiling and Willing Hands
1. HALF-SMILE WHEN YOU FIRST WAKE UP IN THE MORNING.
Hang a branch, any other sign, or even the word “smile” on the ceiling or wall, so that you see it
right away when you open your eyes. This sign will serve as your reminder. Use these seconds
before you get out of bed to take hold of your breath. Inhale and exhale three breaths gently
while maintaining a half-smile. Follow your breaths. Add willing hands to your half-smile, or
practice willing hands alone.
2. HALF-SMILE DURING YOUR FREE MOMENTS.
Anywhere you find yourself sitting or standing, half-smile. Look at a child, a leaf, a painting on a
wall, or anything that is relatively still, and smile. Inhale and exhale quietly three times.
3. HALF-SMILE WITH WILLING HANDS WHILE YOU ARE LISTENING TO MUSIC.
Listen to a piece of music for 2 or 3 minutes. Pay attention to the words, music, rhythm, and
sentiments of the music you are listening to (not your daydreams of other times). Half-smile
while watching your inhalations and exhalations. Adopt a willing-hands posture.
4. HALF-SMILE WITH WILLING HANDS WHEN YOU ARE IRRITATED.
When you realize “I’m irritated,” half-smile or adopt a willing-hands posture at once. Inhale and
exhale quietly, maintaining a half-smile or willing hands for three breaths.
5. HALF-SMILE IN A LYING-DOWN POSITION.
Lie on your back on a flat surface, without the support of mattress or pillow. Keep your two arms
loosely by your sides, and keep your two legs slightly apart, stretched out before you. Maintain
willing hands and a half-smile. Breathe in and out gently, keeping your attention focused on
your breath. Let go of every muscle in your body. Relax each muscle as though it were sinking
down through the floor, or as though it were as soft and yielding as a piece of silk hanging in
the breeze to dry. Let go entirely, keeping your attention only on your breath and half-smile.
Think of yourself as a cat, completely relaxed before a warm fire, whose muscles yield without
resistance to anyone’s touch. Continue for 15 breaths.
6. HALF-SMILE IN A SITTING POSITION.
Sit on the floor with your back straight, or on a chair with your two feet touching the floor. Halfsmile. Inhale and exhale while maintaining the half-smile. Let go.
54
7. HALF-SMILE WITH WILLING HANDS WHILE YOU ARE CONTEMPLATING A PERSON
YOU DISLIKE OR ARE ANGRY WITH.
• Sit quietly. Breathe and smile a half-smile. Hold your hands open with palms up.
• Imagine the image of the person who has caused you suffering.
• Regard the features you dislike the most or find the most repulsive.
• Try to examine what makes this person happy and what causes suffering in his or her
daily life.
• Imagine the person’s perceptions; try to see what patterns of thought and reason this
person follows.
• Examine what motivates this person’s hopes and actions.
• Finally, consider the person’s consciousness. See whether the person’s views and
insights are open and free or not, and whether or not the person has been influenced by
any prejudices, narrow-mindedness, hatred, or anger.
• See whether or not the person is master of him- or herself.
• Continue until you feel compassion rise in your heart like a well filling with fresh water,
and your anger and resentment disappear. Practice this exercise many times on the
same person.
Notes/Other times to half-smile and/or form willing hands:
55
Ways to Practice Accepting Reality
1. Acceptance of reality as it is sometimes requires an act of CHOICE.
2. Breathe mindfully to be in the moment and to help develop a more accepting
mindset.
3. Accept reality with your face: half-smile.
4. Rehearse in your mind those things that you would do if you really did accept
reality as it is.
5. Practice willingness.
6. Remember to turn the mind back to accepting Reality Road.
Accepting
Reality
56
Practicing Radical Acceptance Step by Step
‰‰
Observe that you are questioning or fighting reality (“It shouldn’t be this way”).
‰‰
Remind yourself that the unpleasant reality is just as it is and cannot be changed (“This is
what happened”).
‰‰
Remind yourself that there are causes for the reality. Acknowledge that some sort of history
led up to this very moment. Consider how people’s lives have been shaped by a series of
factors. Notice that given these causal factors and how history led up to this moment, this
reality had to occur just this way (“This is how things happened”).
‰‰
Practice accepting with the whole self (mind, body, and spirit). Be creative in finding ways
to involve your whole self. Use accepting self-talk—but also consider using relaxation;
mindfulness of your breath; half-smiling and willing hands while thinking about what feels
unacceptable; prayer; going to a place that helps bring you to acceptance; or imagery.
‰‰
Practice opposite action. List all the behaviors you would do if you did accept the facts. Then
act as if you have already accepted the facts. Engage in the behaviors that you would do if you
really had accepted.
‰‰
Cope ahead with events that seem unacceptable. Imagine (in your mind’s eye) believing what
you don’t want to accept. Rehearse in your mind what you would do if you accepted what
seems unacceptable.
‰‰
Attend to body sensations as you think about what you need to accept.
‰‰
Allow disappointment, sadness, or grief to
you.
‰‰
Acknowledge that life can be worth living even when there is pain.
‰‰
Do pros and cons if you find yourself resisting practicing acceptance.
57
Mindfulness of Current Thoughts
1. OBSERVE YOUR THOUGHTS.
•
•
•
•
•
As waves, coming and going.
Not suppressing thoughts.
Not judging thoughts.
Acknowledging their presence.
Not keeping thoughts around.
• Not analyzing thoughts.
• Practicing willingness.
• Stepping back and observing
thoughts as they run in and out of
your mind.
2. ADOPT A CURIOUS MIND.
• Ask, “Where do my thoughts come from?” Watch and see.
• Notice that every thought that comes also goes out of your mind.
• Observe but do not evaluate your thoughts. Let go of judgments.
3. REMEMBER: YOU ARE NOT YOUR THOUGHTS.
•
•
•
•
Do not necessarily act on thoughts.
Remember times when you have had very different thoughts.
Remind yourself that catastrophic thinking is “emotion mind.”
Remember how you think when you are not feeling such intense suffering
and pain.
4. DON’T BLOCK OR SUPPRESS THOUGHTS.
• Ask, “What sensations are these thoughts trying to avoid?” Turn your mind
to the sensation. Then come back to the thought. Repeat several times.
• Step back; allow your thoughts to come and go as you observe your breath.
• Play with your thoughts: Repeat them out loud over and over as fast as
you can. Sing them. Imagine the thoughts as the words of a clown, as
recordings getting all tangled up; as cute animals you can cuddle up to; as
bright colors running through your mind; as only sounds.
• Try loving your thoughts.
58
Practicing Mindfulness of Thoughts
PRACTICE MINDFULNESS OF THOUGHTS BY OBSERVING THEM
‰‰1. Notice thoughts as they come into your mind. As a thought comes into your mind, say
“a thought has entered my mind.” Label the thought as a thought, saying, “The thought
[describe thought] arose in my mind.” Use a gentle voice tone.
‰‰2. As you notice thoughts in your mind, ask, “Where did the thought come from?” Then watch
your mind to see if you can see where it came from.
‰‰3. Step back from your mind, as if you are on top of a mountain and your mind is just a boulder
down below. Gaze at your mind, watching what thoughts come up when you are watching it.
Come back into your mind before you stop.
‰‰4. Close your eyes and scan your body for the first physical sensation that you notice. Then
scan your mind for the first thought you notice. Shuttle back and forth between scanning for
physical sensations and scanning for thoughts. Another time, replace scanning your body
for physical sensations to scanning yourself for any emotional feelings. Then shuttle back
and forth between an emotional feeling and a thought.
PRACTICE MINDFULNESS OF THOUGHTS BY USING WORDS AND VOICE TONE
‰‰5. Verbalize thoughts or beliefs out loud, using a nonjudgmental voice tone, over and over and
over:
‰‰
As fast as you can until the thoughts make no sense.
‰‰
Very, very slowly (one syllable or word per breath).
‰‰
In a different voice from yours (high- or low-pitched, like a cartoon character or celebrity).
‰‰
As a dialogue on a TV comedy show (“You’ll never believe what thought went through
my mind. I was thinking, ‘I’m a jerk.’ Can you believe that?”).
‰‰
As songs, sung wholeheartedly and dramatically, in a tune that fits the thoughts.
PRACTICE MINDFULNESS OF THOUGHTS WITH OPPOSITE ACTION
‰‰6. Relax your face and body while imagining accepting your thoughts as only thoughts—
sensations of the brain.
‰‰7. Imagine things you would do if you stopped believing everything you think.
‰‰8. Rehearse in your mind the things that you would do if you did not view your thoughts as
facts.
‰‰9. Practice loving your thoughts as they go through your mind.
59
PRACTICE MINDFULNESS OF THOUGHTS BY IMAGINING THAT YOUR MIND IS:
‰‰
10. A conveyor belt, and that thoughts and feelings are coming down the belt. Put each thought
or feeling in a box labeled with the type of thought that it is (e.g., worry thoughts, thoughts
about my past, thoughts about my mother, planning what to do thoughts). Just keep
observing and sorting thoughts into the labeled boxes.
‰‰
11. A river, and that thoughts and feelings are boats going down the river. Imagine sitting on the
grass, watching the boats go by. Try not to jump on the boat.
‰‰
12. A railroad track, and that thoughts and feelings are train cars going by. Try not to jump on
the train.
‰‰
13. A leaf that has dropped off a tree into a beautiful creek flowing by you as you sit on the
grass. Each time a thought or image comes into your mind, imagine that it is written or
pictured on the leaf floating by. Let each leaf go by, watching as it goes out of sight.
‰‰
14. The sky, and thoughts have wings and can fly through the sky. Watch as each flies out of
sight.
‰‰
15. The sky, and thoughts are clouds. Notice each thought-cloud as it drifts by, letting it drift out
of your mind.
‰‰
16. A white room with two doors. Through one door, thoughts come in; through the other,
thoughts go out. Watch each thought with attention and curiosity until it leaves. Let go of
judgments. Let go of analyzing thoughts and of figuring out if they fit the facts. As a thought
comes into your mind, say, “A thought has entered my mind.”
Other:
Other:
Other:
Other:
Other:
60
Mindfulness of Current Thoughts
Due Date:
Name:
Week Starting:
Describe your efforts to observe your thoughts in the past week. Practice observing thoughts each
day at least once. Don’t focus just on thoughts that are painful, anxiety-provoking, or full of anger;
also observe and be mindful of pleasant or neutral thoughts. For each thought, first practice saying,
“The thought [describe thought] went through my mind.” Then practice one or more strategies to
observe and let go of thoughts.
Check off any of the following exercises that you did.
‰‰1. Used words and voice tone to say a thought over and over; as fast as I could; very, very
slowly; in a voice different from mine; as a dialogue on a TV comedy show; or as singing.
‰‰2. Relaxed my face and body imagining accepting my thoughts as sensations of my brain.
‰‰3. Imagined what I would do if I stopped believing everything I think.
‰‰4. Rehearsed in my mind what I would do if I did not view my thoughts as facts.
‰‰5. Practiced loving my thoughts as they went through my mind.
‰‰6. Refocused my mind on sensations I was avoiding by worrying or catastrophizing.
‰‰7. Allowed my thoughts to come and go as I focused on observing my breath coming in and
out.
‰‰8. Labeled the thought as a thought, saying, “The thought [describe thought] arose in my
mind.”
‰‰9. Asked, “Where did the thought come from?” and watched my mind to find out.
‰‰
10. Stepped back from my mind, as if I was on top of a mountain.
‰‰
11. Shuttled back and forth between scanning for physical sensations and scanning for
thoughts.
‰‰
12. Imagined that in my mind thoughts were coming down a conveyor belt; were boats on a
river; were train cars on a railroad track; were written on leaves flowing down a river; had
wings and could fly away; were clouds floating in the sky; or were going in and out of the
doors of my mind. (Underline the image you used.)
‰‰
13. Other:
Describe thoughts you were mindful of during the week. State just each thought as it went through
your mind.
1. Thought:
Describe strategies you used or give numbers from above:
Circle how effective was this at helping you be more mindful and less reactive:
1
Not effective
2
3
Somewhat effective
4
5
Very effective
2. Thought:
Describe strategies you used or give numbers from above:
Circle how effective was this at helping you be more mindful and less reactive:
1
Not effective
2
3
Somewhat effective
4
5
Very effective
3. Thought:
Describe strategies you used or give numbers from above:
Circle how effective was this at helping you be more mindful and less reactive:
1
Not effective
2
3
Somewhat effective
61
4
5
Very effective
Overview:
When the Crisis Is Addiction
Skills for backing down from addiction.
You can remember them as A, , , .
A
⎧
⎪
⎪
⎪
⎪
⎨
⎪
⎪
⎪
⎪
⎩
B
C
D
ALTERNATE REBELLION
ADAPTIVE DENIAL
BURNING BRIDGES
AND BUILDING NEW ONES
⎧
⎪
⎪
⎪
⎪
⎨
⎪
⎪
⎪
⎪
⎩
CLEAR MIND
COMMUNITY REINFORCEMENT
DIALECTICAL ABSTINENCE
62
Common Addictions
In case you thought you had no addictions, here is a list.
You are addicted when you are unable to stop a behavior pattern or use of
substances, despite negative consequences and despite your best efforts to stop.
‰‰
Alcohol
‰‰
Internet games
‰‰
Attention seeking
‰‰
Kleptomania/stealing/shoplifting
‰‰
Avoiding:
‰‰
Lying
‰‰
Auto racing
‰‰
Pornography
‰‰
Betting
‰‰
Reckless driving
‰‰
Bulimia (purging/vomiting)
‰‰
Risky behaviors
‰‰
Cheating
‰‰
Self-inflicted injury/self-mutilation
‰‰
Coffee
‰‰
Sex
‰‰
Colas
‰‰
Shopping
‰‰
Collecting:
‰‰
Art
‰‰
Coins
‰‰
Junk
‰‰
Clothes
‰‰
Shoes
‰‰
Music
‰‰
Other:
‰‰
Other:
‰‰
Sleeping
‰‰
Smartphone apps
‰‰
Smoking/tobacco
‰‰
Social networking
‰‰
Speed
‰‰
Spiritual practices
‰‰
Diuretics
‰‰
Sports activities:
‰‰
Biking
‰‰
Body building
‰‰
Hiking/rock climbing
‰‰
Running
‰‰
Weight lifting
‰‰
Other:
‰‰
Other:
‰‰
E-mail
‰‰
Television
‰‰
Food/eating
‰‰
Carbohydrates
‰‰
Chocolate
‰‰
Specific food:
‰‰
Texting
‰‰
Gambling
‰‰
Working
‰‰
Computers
‰‰
Criminal activities
‰‰
Dieting
‰‰
Drugs (illicit and prescribed)
‰‰
Vandalism
‰‰
Videos
‰‰
Video games
‰‰
Games/puzzles
‰‰
Gossiping
‰‰
Other:
‰‰
Imagining/fantasizing
‰‰
Other:
‰‰
Internet
‰‰
Other:
63
Alternate Rebellion and Adaptive Denial
ALTERNATE REBELLION
When addictive behaviors are a way to rebel against authority, conventions, and the boredom
of not breaking rules or laws, try alternate rebellion. Alternate rebellion replaces destructive
rebellion and keeps you on a path to your goals.
Examples:
‰
‰
‰
‰
‰
‰
‰
‰
‰
Shave your head.
‰
Wear crazy underwear.
‰
Wear unmatched shoes.
‰
Have secret thoughts.
‰
Express unpopular views.
‰
Do random acts of kindness.
‰
.
‰
Write a letter saying exactly what you want.
‰‰
Dye your hair a wild color.
‰‰
Get a tattoo or body piercing.
‰‰
Wear clothes inside out.
‰‰
Don’t bathe for a week.
‰‰
Print a slogan on a t-shirt.
‰‰
Paint your face.
‰‰
Dress up or dress down where
doing so is unexpected.
ADAPTIVE DENIAL
When your mind can’t tolerate craving for addictive behaviors, try adaptive denial.
‰‰
Give logic a break when you are doing this. Don’t argue with yourself.
‰‰
When urges hit, deny that you want the problem behavior or substance. Convince yourself
you want something other than the problem behavior. For example, reframe an urge to
have a cigarette as an urge to have a flavored toothpick; an urge to have alcohol as an
urge to have something sweet; or an urge to gamble as an urge to alternate rebellion (see
above).
Other:
Other:
Be adamant with yourself in your denial, and engage in the alternative behavior.
‰‰
Put off addictive behavior. Put it off for 5 minutes, then put it off for another 5 minutes, and
so on and on, each time saying, “I only have to stand this for 5 minutes.” By telling yourself
each day you will be abstinent for today (or each hour for just this hour, and so on), you are
saying, “This is not forever. I can stand this right now.”
64
Practicing Alternate Rebellion and Adaptive Denial
Due Date:
Name:
Week Starting:
Check and describe plans for alternate rebellion when the urge for addictive behaviors
arises:
‰‰
1.
‰‰
2.
‰‰
3.
Check and describe what you actually did as alternative behaviors instead of giving in
to addictive behaviors:
‰‰
1.
‰‰
2.
Circle how effective alternate rebellion was at helping you survive the urges without giving in
to addiction.
1
Not effective
2
3
Somewhat effective
4
5
Very effective
Check off and describe adaptive denial skills below that you used to manage urges:
‰‰
1. Reframing an urge for a problem behavior as an urge for something else:
Circle how effective this was at helping you survive the urges without giving in to addiction.
1
Not effective
2
‰‰
2. Putting off addictive behavior for
3
Somewhat effective
minutes,
4
5
Very effective
times:
Circle how effective this was at helping you survive the urges without giving in to addiction.
1
Not effective
2
3
Somewhat effective
4
5
Very effective
‰‰
3. Reminded myself I only had to be abstinent for an hour, a day,
or
.
Circle how effective this was at helping you survive the urges without giving in to addiction.
1
Not effective
2
3
Somewhat effective
65
4
5
Very effective
Burning Bridges and Building New Ones
BURNING BRIDGES
Accept at the most radical level that you are not going to engage in addictive behavior
again, and then move actively to cut off all addictive behavior options.
‰‰
1. Make an absolute commitment to abstinence from the addictive behavior, which is
(describe addictive behavior). Then walk into the garage of
abstinence and slam the garage door shut. (Remember that the tiniest slit of space
can let an entire elephant in.)
‰‰
2. List everything in your life that makes addiction possible.
‰‰
3. Get rid of these things:
‰‰
Throw out contact information of people who collude with you.
‰‰
Get rid of all possible cues and temptations.
‰‰
4. List and do everything you can that will make it hard or impossible to continue your
addictive behavior.
‰‰
Ruthlessly and at every moment, tell the truth about your behavior.
‰‰
Tell all your friends and family that you have quit.
BUILDING NEW BRIDGES
Create visual images and smells that will compete with the information loaded into
your visual and olfactory brain systems when cravings occur.
Cravings and urges are strongly related to vivid images and smells of what is craved. The stronger the imagery or smell, the stronger the craving.
‰‰
Build different images or smells to think about. Try to keep these images or smells
in memory when you have an unwanted craving. For example, whenever you crave
a cigarette, imagine being on the beach; see and smell it in your mind to reduce the
craving.
‰‰
When you have unwanted cravings, look at moving images or surround yourself with
smells unrelated to the addiction. Moving images and new smells will compete with your
cravings.
‰‰
“Urge-surf” by imagining yourself on a surfboard riding the waves of your urges. Notice
them coming and going, rising high, going low, and finally going away.
66
Burning Bridges and Building New Ones
Due Date:
Name:
Week Starting:
Rate the strength of your slamming the door on your addiction, from 0 (no intention of quitting addictive behavior) to 100 (complete and absolute commitment):
. Go into Wise Mind and rate your
level of slamming the door again:
.
List all the things in your life that make addiction possible. Check those you get rid of.
‰‰
‰‰
‰‰
‰‰
‰‰
‰‰
List all tempting people, websites, and other contact information you need to continue addictive
behaviors. Check those you erase or otherwise get rid of.
‰‰
‰‰
‰‰
‰‰
‰‰
‰‰
List all the things that would make addiction impossible. Check those that you do.
‰‰
‰‰
‰‰
‰‰
‰‰
‰‰
Describe imagery you can use to help reduce cravings:
Check and describe each strategy you have used to battle addiction urges.
‰‰
Kept new imagery in mind when urges hit:
‰‰
Looked at moving images:
‰‰
Surrounded self with new smells:
‰‰
Urge-surfed:
67
ADDICT
MIND
FOGGY MIND
Clear Mind
CLEAR
MIND
Addict mind is:
CLEAN
MIND
Clean mind is:
Impulsive
Naive
One-minded
Risk-taking
Willing to do anything for a “fix”
Oblivious to dangers
When in addict mind, you are ruled
by the addiction. The urges for habitual
problem behaviors determine your
thoughts, emotions, and behaviors.
When in clean mind, you are clean
but oblivious to dangers that might
cue habitual problem behaviors. You
believe you are invincible and immune
to future temptation.
Both extremes are DANGEROUS!
CLEAR MIND: The safest place to be.
You are clean, but you remember addict mind.
You radically accept that relapse is not impossible.
You enjoy your success, while still expecting urges and cues
and planning for when you’re tempted.
68
Behavior Patterns Characteristic of Addict Mind
and of Clean Mind
ADDICT MIND
CLEAN MIND
v Engaging in addictive behavior.
v Engaging in apparently irrelevant behaviors
that in the past inevitably led to addictive
behavior.
v Thinking, “I don’t really have a problem with
addiction.”
v Thinking, “I’ve learned my lesson.”
v Thinking, “I can do a little.”
v Thinking, “I can control the habit.”
v Thinking, “I can indulge my habit, if only on
weekends.”
v Thinking, “I don’t really have an addiction
problem any more.”
v Thinking, “I can’t stand this!”
v Stopping or cutting back medication that helps
with addiction.
v Glamorizing addiction.
v Surfing the Internet for ways to engage in
addictive behaviors.
v Being in environments where others engage in
addictive behaviors.
v Buying paraphernalia (food, drugs, videos,
etc.) for addictive behavior.
v Seeing friends who are still addicted.
v Living with people who are addicted.
v Selling or exchanging items related to
addictive behaviors.
v Keeping addiction paraphernalia.
v Stealing to pay for addiction.
v Carrying around extra money.
v Prostituting for money or for paraphernalia.
v Being irresponsible with bills.
v Lying.
v Dressing like an addict.
v Hiding.
v Not going to meetings.
v Isolating.
v Not confronting the problems that fuel my
addictive behaviors.
v Acting always busy; “Got to go!”
v Acting as if only willpower is needed.
v Breaking promises.
v Isolating.
v Committing crimes.
v Believing, “I can do this alone.”
v Acting like a corpse.
v Thinking, “I can take pain medicine/diet/engage
in addictive behavior if prescribed or advised; I
don’t need to say anything about my past
addiction.”
v Having “no life.”
v Acting desperate/obsessed.
v Not looking people in the eyes.
v Thinking, “I can’t stand this!”
v Having poor hygiene.
v Other:
v Avoiding doctors.
v Other:
v Other:
v Other:
v Other:
v Other:
69
From Clean Mind to Clear Mind
Due Date:
Name:
Week Starting:
Check off each clean mind behavior you plan on changing this week. During the week, write down
the clear mind behavior you did to replace clean mind.
CLEAN MIND BEHAVIORS
CLEAR MIND BEHAVIORS AS REPLACEMENTS
‰‰1. Engaging in apparently irrelevant
behaviors that in the past inevitably
led to problem behavior.
‰‰2. Thinking, “I’ve learned my lesson.”
‰‰3. Believing, “I can control my
addiction.”
‰‰4. Thinking, “I don’t really have an
addiction.”
‰‰5. Stopping or cutting back
medication that helps with
addiction.
‰‰6. Being in addiction environments.
‰‰7. Seeing friends who are still
addicted.
‰‰8. Living with people who are
addicted.
‰‰9. Keeping addiction paraphernalia.
‰‰
10. Carrying around extra money.
‰‰
11. Being irresponsible with bills.
‰‰
12. Dressing like an addict.
‰‰
13. Not going to meetings.
‰‰
14. Isolating.
‰‰
15. Believing, “I can do this alone.”
‰‰
16. Ignoring problems fueling addiction.
‰‰
17. Acting as if I only need willpower.
‰‰
18. Thinking, “I don’t need to say
anything about my addiction.”
‰‰
19. Thinking, “I can’t stand this!”
‰‰
20. Other:
‰‰
21. Other:
70
Community Reinforcement
Community reinforcement means replacing addiction reinforcers
with abstinence reinforcers.
REINFORCING ABSTINENCE IS CRITICAL
Reinforcers in your environment play a powerful role in encouraging or discouraging addictive
behaviors.
To stop addictive behavior, you have to figure out how to make a lifestyle without your
addictive behaviors more rewarding than a lifestyle with your addictive behaviors.
You have to find a way to get behaviors incompatible with addictions to pay off and be
rewarded by those around you.
Willpower is not sufficient. If it were, we would all be perfect!
REPLACE ADDICTION REINFORCERS WITH ABSTINENCE REINFORCERS
Begin a series of action steps that will increase your chances of accumulating positive events
to replace addictive behavior.
‰‰
Search for people to spend time with who aren’t addicted.
‰‰
Increase the number of enjoyable activities you engage in that do not involve your
addiction.
‰‰
If you cannot decide what people or activities you like, sample a lot of different groups of
people and a lot of different activities.
ABSTINENCE SAMPLING
‰‰
Commit to
days off your addiction, and observe the benefits that naturally occur.
‰‰
Temporarily avoid high-risk addiction triggers, and replace these with competing behaviors
to get you through the sampling period.
‰‰
Observe all the extra positive events occurring when you are not engaging in addictive
behaviors.
Note. Adapted from Meyers, R. J., & Squires, D. D. (2001, September). The community reinforcement approach. Retrieved from www.bhrm.org/
guidelines/CRAmanual.pdf. Adapted by permission of the authors.
71
Reinforcing Nonaddictive Behaviors
Due Date:
Name:
Week Starting:
Check off and describe each effort you made to replace addiction reinforcers with abstinence
reinforcers.
‰‰
1. Searched for people to spend time with who aren’t addicted. Describe what you did and who
you found.
‰‰
2. Increased number of enjoyable, nonaddictive activities. Describe activities.
‰‰
3. Sampled different groups and different activities. Describe what you did and what you found.
‰‰
4. Took one or more action steps to build positive events to replace addiction. Describe.
Check off and describe your abstinence-sampling efforts.
‰‰
5. Committed to
days of abstinence. (Stayed abstinent
Describe abstinence plan and how you implemented it. (See
days.)
)
‰‰
6. Observe and describe positive events that occurred when you were not engaging in addictive
behaviors.
Nonaddictive activity
Positive events and consequences
72
Dialectical Abstinence
ABSTINENCE
(Swearing off
addictive behavior)
vs.
Pro: People who commit to
abstinence stay off longer.
HARM REDUCTION
(Acknowledging there will be
slips; minimizing the damage,
but not demanding perfection)
Pro: When a slip does happen,
people can get back “on the
wagon” faster.
Con: It takes longer for people
to get back “on the wagon”
once they fall off.
Con: People who commit to
harm reduction relapse quicker.
SYNTHESIS = DIALECTICAL ABSTINENCE
The goal is not to engage in addictive behavior again—
in other words, to achieve complete abstinence.
However, if there is a slip, the goal is to minimize harm
and get back to abstinence as soon as possible.
Pros: It works!
Cons: It’s work. You don’t get a vacation.
(You’re always either abstinent or working to get back to abstinence.)
An example of expecting the best and planning for the trouble spots:
Olympic athletes must believe and behave as though they can win
every race, even though they have lost before and will lose again.
73
Skills When the Crisis Is Addiction
Due Date:
Name:
Week Starting:
Check off two skills for backing down from addiction to practice this week during a stressful
situation:
‰‰
Sample abstinence for
days
‰‰
Burn bridges
‰‰
Build new bridges
‰‰
Practice alternate rebellion
‰‰
Practice adaptive denial
‰‰
Plan for abstinence
‰‰
Plan for harm reduction
‰‰
Practice clear mind
‰‰
Search for abstinence reinforcers
‰‰
Increase non-addicting pleasant events
Skill 1. Describe the situation and how you practiced the skill:
How effective was the skill in helping you cope with the situation (keeping you from doing
something to make the situation worse)? Circle a number below.
I still couldn’t stand
the situation, even
for one more minute.
1
2
I was able to cope somewhat,
at least for a little while.
It helped somewhat.
3
4
I could use skills,
tolerated distress, and
resisted problem urges.
5
Did this skill help you cope with uncomfortable emotions or urges, or avoid conflict of any
kind? Circle YES or NO.
Describe how the skill helped or did not help:
Skill 2. Describe the situation and how you practiced the skill:
How effective was the skill in helping you cope with the situation (keeping you from doing
something to make the situation worse)? Circle a number below.
I still couldn’t stand
the situation, even
for one more minute.
1
2
I was able to cope somewhat,
at least for a little while.
It helped somewhat.
3
4
I could use skills,
tolerated distress, and
resisted problem urges.
5
Did this skill help you cope with uncomfortable emotions or urges, or avoid conflict of any
kind? Circle YES or NO.
Describe how the skill helped or did not help:
74
Planning for Dialectical Abstinence
Plan for Abstinence
‰‰1.
‰‰2.
‰‰3.
‰‰4.
‰‰5.
Enjoy your success, but with a clear mind; plan for temptations to relapse.
Spend time or touch base with people who will reinforce you for abstinence.
Plan reinforcing activities to do instead of addictive behaviors.
Burn bridges: Avoid cues and high-risk situations for addictive behaviors.
Build new bridges: Develop images, smells, and mental activities (such as,
urge surfing) to compete with information associated with craving.
‰‰6. Find alternative ways to rebel.
‰‰7. Publicly announce abstinence; deny any idea of lapsing to addiction.
Plan for Harm Reduction
‰
‰
‰
‰
‰
1.
2.
3.
4.
5.
Call your therapist, sponsor, or mentor for skills coaching.
Get in contact with other effective people who can help.
Get rid of temptations; surround yourself with cues for effective behaviors.
Review skills and handouts from DBT.
Opposite action (Emotion Regulation
12 ) can be rehearsed
to fight guilt and shame. If no other option works, go to an anonymous
meeting of any sort and publicly report your lapse.
‰ 6. Building mastery and coping ahead for emotional situations (Emotion
Regulation
14 ), and checking the facts (Emotion Regulation
12 ), can be used to fight feelings of being out of control.
‰ 7. Interpersonal skills (Interpersonal Effectiveness
1 ), such as
asking for help from family, friends, sponsors, ministers, or counselors,
can also be helpful. If you are isolated, help can often be found via online
support groups.
‰ 8. Conduct a chain analysis to analyze what prompted the lapse.
‰‰9. Problem-solve right away to find a way to “get back on the wagon” and
repair any damage you have done (Emotion Regulation
12 ).
‰‰
10. Distract yourself, self-soothe, and improve the moment.
‰‰
11. Cheerlead yourself.
‰‰
12. Do pros and cons of stopping addictive behaviors (Distress Tolerance
4 ).
‰‰
13. Stay away from extreme thinking. Don’t let one slip turn into a disaster.
‰‰
14. Recommit to 100% total abstinence.
75
Planning for Dialectical Abstinence
Due Date:
Name:
Week Starting:
Problem Behavior:
Check each activity and describe what you did.
PLAN FOR ABSTINENCE
To maximize the chances I’ll stop
, I need to aim for abstinence.
‰‰
Plan activities to do instead of problem behaviors (e.g., work, find a hobby, go to a support
meeting, volunteer). These will include:
‰‰
Spend time or touch base with people who will reinforce my not engaging in problem behaviors
and my engaging in effective behaviors (e.g., effective friends or family members, co-workers,
employers, my therapist, people from group). These people include:
‰‰
Remind myself of reasons to stay abstinent and be effective (e.g., to reach long-term goals, to
keep/get relationship, to save money, to avoid shame). These include:
‰‰
Burn bridges with people who represent a temptation (e.g., lose their numbers, unfriend them,
tell them to stop contacting me, make them not want to hang out with me). These people
include:
‰‰
Avoid cues for problem behaviors. Cues include:
76
‰‰
Use skills (things to do to avoid urges, interpersonal effectiveness, distress tolerance, emotion
regulation, mindfulness). The most useful skills for me include:
‰‰
Find alternative ways to rebel. These include:
‰‰
Publicly announce I’ve embraced abstinence and effective behavior.
PLAN FOR HARM REDUCTION
If I have a slip, I don’t want the slip to turn into a slide. To avoid a slide, I must have plans to regain
my balance and get back to abstinence and effectiveness.
‰‰
Call my therapist, sponsor, or mentor for skills coaching. His or her number is:
‰‰
Get in contact with other effective people who can help (e.g., friends or family, people from
group). These people include (with contact information):
‰‰
Get rid of the temptations (e.g., drugs, comfort food); surround myself with cues for effective
behaviors (e.g., workout clothes, fruit).
‰‰
Review skills and handouts from DBT. The most helpful skills/handouts for me are:
‰‰
Opposite action (Emotion Regulation
12 ) can be rehearsed to fight guilt and shame.
If no other option works, go to an anonymous meeting of any sort and publicly report your lapse.
‰‰
Building mastery and coping ahead for emotional situations (Emotion Regulation
14 ),
and checking the facts (Emotion Regulation
12 ), can be used to fight feelings of being
out of control.
77
‰ Interpersonal skills (Interpersonal Effectiveness
1 ), such as asking for help from
family, friends, sponsors, ministers, or counselors, can also be helpful. If you are isolated, help
can often be found via online support groups. These people or groups include:
‰ Conduct a chain analysis to analyze what prompted the lapse.
‰ Problem-solve right away to find a way to “get back on the wagon” and repair any damage you
have done (Emotion Regulation
12 ).
‰ Distract yourself, self-soothe, and improve the moment.
‰ Cheerlead myself (e.g., “One slip is not a disaster,” “Don’t give up,” “Don’t get willful,” “I can
still climb back on the wagon.”) My cheerleading statements will include:
‰‰
Do pros and cons of stopping again now.
‰‰
Stay away from extreme thinking. Always look for the middle ground. Don’t let one slip turn into
a disaster. (Check each extreme thought I am giving up and the middle ground I am accepting.)
Extreme thinking:
Middle ground:
‰‰
I have not quit yet; therefore I am
doomed and might as well give up.
‰‰
Relapsing once does not doom me to
never stopping.
‰‰
Now that I’ve relapsed, I might as well
keep going.
‰‰
I relapsed, but that does not mean
I have to stay relapsed. I can be
effective and get up now.
‰‰
I missed an appointment, so I’m done
with treatment.
‰‰
I missed an appointment, but I can get
in to see my therapist ASAP.
‰‰
Other:
‰‰
Other:
‰‰
Other:
‰‰
Other:
‰‰
Recommit to 100% total abstinence.
78
WALKING THE MIDDLE PATH
79
Dialectics: What Is It?
Dialectics teach us that:
• There is always more than one way to see a situation and more than one way to
solve a problem.
• All people have unique qualities and different points of view.
• Change is the only constant.
• Two things that seem like (or are) opposites can both be true.
• Honor the truth on both sides of a conflict. This does not mean giving up your
values or selling out. Avoid seeing the world in “black-and-white,” “all-ornothing” ways.
Acceptance
Acceptance
AND
Change =
MIDDLE
PATH
Change
Examples:
I am doing the best I can AND I need to do better, try harder, and be more
motivated to change.
I can do this AND it’s going to be hard. My mom is really strict AND she really
cares about me. I’ve got big problems AND I can try to solve them. You are
tough AND you are gentle.
This perspective helps pave the way toward
the middle path by helping you:
• Expand your thoughts and ways of considering
life situations.
• “Unstick” standoffs and conflicts.
• Be more flexible and approachable.
• Avoid assumptions and blaming.
80
Dialectics “How-to” Guide
Hints for Thinking and Acting Dialectically:
1. Move to “both–and” thinking and away from “either/or” thinking. Avoid extreme
words: always, never, you make me. Be descriptive.
Example: Instead of saying “Everyone always treats me unfairly,” say
“Sometimes I am treated fairly and at other times, I am treated unfairly.”
2. Practice looking at all sides of a situation and all points of view. Be generous
and dig deep. Find the kernel of truth in every side by asking “What is being left
out?”
Example: “Why does Mom want me to be home at 10:00 P.M.?” “Why does my
daughter want to stay out until 2:00 A.M.?
3. Remember: No one has the absolute truth. Be open to alternatives.
4. Use “I feel . . . ” statements, instead of “You are . . . ,” “You should . . . ,” or “That’s
just the way it is” statements.
Example: Say “I feel angry when you say I can’t stay out later just because you
said so” instead of, “You never listen and you are always unfair to me.”
5. Accept that different opinions can be valid, even if you do not agree with them.
Example: “I can see your point of view even though I do not agree with it.”
6. Check your assumptions. Do not assume that you know what others are
thinking.
Example: “What did you mean when you said . . . ?”
7. Do not expect others to know what you are thinking.
Example: “What I am trying to say is. . . . ”
81
Examples of Opposite Sides That Can Both Be True
1. You can want to change and be doing the best you can, AND still need to do better, try
harder, and be more motivated to change.
2. You are tough AND you are gentle.
3. You can be independent AND also want help. (You can allow somebody else to be
independent AND also give them help.)
4. You can want to be alone AND also want to be connected to others.
5. You can share some things with others AND also keep some things private.
6. You can be by yourself AND still be connected to others.
7. You can be with others AND be lonely.
8. You can be a misfit in one group AND fit in perfectly in another group. (A tulip in a rose
garden can also be a tulip in a tulip garden.)
9. You can accept yourself the way you are AND still want to change. (You can accept others
as they are AND still want them to change.)
‰
10. At times you need to both control AND tolerate your emotions.
‰
11. You may have a valid reason for believing what you believe, AND you may still be wrong or
incorrect.
‰
12. Someone may have valid reasons for wanting something from you, AND you may have valid
reasons for saying no.
‰
13. The day can be sunny, AND it can rain.
‰
14. You can be mad at somebody AND also love and respect the person.
‰
15. (You can be mad at yourself AND also love and respect yourself.)
‰
16. You can have a disagreement with somebody AND also be friends.
‰
17. You can disagree with the rules AND also follow the rules.
‰
18. You can understand why somebody is feeling or behaving in a certain way, AND also
disagree with his or her behavior and ask that it be changed.
‰
19. Others:
82
Important Opposites to Balance
1. Accepting reality AND working to change it.
2. Validating yourself and others AND acknowledging errors.
3. Working AND resting.
4. Doing things you need to do AND doing things you want to do.
5. Working on improving yourself AND accepting yourself exactly as you are.
6. Problem solving AND problem acceptance.
7. Emotion regulation AND emotion acceptance.
8. Mastering something on your own AND asking for help.
9. Independence AND dependence.
‰
10. Openness AND privacy.
‰
11. Trust AND suspicion.
‰
12. Watching and observing AND participating.
‰
13. Taking from others AND giving to others.
‰
14. Focusing on yourself AND focusing on others.
‰
15. Others:
‰
16. Others:
‰
17. Others:
83
Dialectics Checklist
Due Date:
Name:
Week Starting:
Everyday dialectical practice: Check off dialectical practice exercises each time you do one. For
each skill you practice, give it a rating to indicate how effective that skill was in helping you reach
your personal and interpersonal goals. Rate from a low of 1 (not at all effective) to a high of 5 (very
effective).
Rating
Looked at both sides:
(1–5)
‰‰‰‰ 1. Asked Wise Mind: “What am I missing?”
‰‰‰‰ 2. Looked for the kernel of truth in another person’s side.
‰‰‰‰ 3. Stayed away from extremes (such as “always” or never”), and instead thought
or said:
Validated both myself and a person
‰‰‰‰ 4. Balanced opposites in my life: ‰‰
I disagreed with ‰‰
Accepted reality and tried to change it ‰‰
Stayed
attached and also let go ‰‰
Other (describe):
‰‰‰‰ 5. Made lemonade out of lemons (describe):
‰‰‰‰ 6. Embraced confusion (describe):
‰‰‰‰ 7. Played devil’s advocate by arguing both my side and also the other side
(describe):
‰‰‰‰ 8. Used a metaphor or story to describe my own point of view (describe):
‰‰‰‰ 9. Did 3-minute Wise Mind to slow down “doing mind” in my everyday life.
‰‰‰‰10. Other (describe):
Stayed aware of my connection:
‰‰‰‰11. Treated others as I want to be treated (describe):
‰‰‰‰12. Looked for similarities between myself and others (describe):
‰‰‰‰13. Noticed the physical connections between all things (describe):
‰‰‰‰14. Other (describe):
Embraced change:
‰‰‰‰15. Practiced radical acceptance of change (describe):
‰‰‰‰16. Purposely made changes in small ways to get used to change (describe):
‰‰‰‰17. Other (describe):
Remembered that change is transactional:
‰‰‰‰18. Paid attention to my effect on others (describe):
‰‰‰‰19. Paid attention to effect of others on me (describe):
‰‰‰‰20. Practiced letting go of blame (describe):
‰‰‰‰21. Reminded myself that all things, including all behaviors, are caused
‰‰‰‰22. Other (describe):
84
Thinking Mistakes
1. ALL-OR-NOTHING, BLACK-AND-WHITE THINKING: If you’re not perfect, you’re a total
loser. If you don’t get everything you want, it feels like you got nothing. If you’re having a
good day, the whole rest of your life is perfect and you don’t need therapy anymore.
2. CATASTROPHIZING (FORTUNETELLING ERROR): You predict the future negatively
without considering other, more likely outcomes. “I’m definitely going to fail my test,” or “If
I tell her that, she’ll hate me forever.”
3. MIND READING: You believe you know what other people are thinking even without
asking. “He clearly doesn’t think I will do a good job.”
4. OVERGENERALIZATION: You make a sweeping, negative conclusion that goes far
beyond the current situation. “Since I felt uncomfortable in my first day of class, I know
that I won’t be able to enjoy the rest of the year.”
5. MENTAL FILTER: You develop selective hearing and vision and only hear and see the one
negative thing and ignore the many positive things. “Because my supervisor gave me
one low rating on my evaluation (that also had many higher ratings), it means I’m doing
a terrible job.”
6. DISQUALIFYING THE POSITIVE: You tell yourself that the positive experiences, actions, or
qualities do not count. “I did well in that one basketball game because I just got lucky.”
7. EMOTIONAL REASONING: You start thinking your emotions are fact. “I feel . . . ;
therefore, it is. I feel like she hates me; therefore, she does.” “I feel stupid; therefore I am
stupid.” “I dread school, so it’s a bad idea to go.”
8. “SHOULD” STATEMENTS: You “should” on yourself or someone else by having a fixed
idea of how you or others should behave, and you overestimate how bad it will be if
these expectations are not met. “It’s terrible that I made a mistake; I should always do
my best.” “You shouldn’t be so upset.”
9. LABELING: Overgeneralization is taken a step further by the use of extreme language to
describe things. “I spilled my milk. I am SUCH A LOSER!” “My therapist didn’t call me right
back; she is the most uncaring, heartless therapist ever!”
10. PERSONALIZATION: You see yourself as the cause for things you have absolutely no
control over or the target of stuff that may have absolutely nothing to do with you. “My
parents divorced because of me.” “The receptionist was short with me because I did
something wrong.”
85
Dialectical Dilemmas
f
light o
g
n
i
k
viors
Ma
beha
m
ble
pro
Forcing ind
epen
den
ce
Too loose
Too strict
pica
y
t
f
o
much avior
o
o
t
g
h
Makin
nt be
e
c
s
e
l
o
ad
Fos
terin
g de
penden
ce
86
l
Dialectical Dilemmas:
How Does the Dilemma Apply to You?
Too loose
Too strict
Have clear rules and enforce them consistently
AND AT THE SAME TIME
Be willing to negotiate on some issues and don’t overuse consequences
Making too
much of typical
adolescent
behavior
Making light
of problem
behaviors
Recognize when a behavior “crosses the line” and get help for that behavior
AND AT THE SAME TIME
Recognize which behaviors are part of typical adolescent development
Fostering
dependence
Forcing
independence
Give your adolescent guidance, support, and coaching to help figure out how to be
responsible
AND AT THE SAME TIME
SLOWLY give your adolescent greater amounts of freedom and independence while
continuing to encourage an appropriate amount of reliance on others
Place an “X” on each continuum to note where you are, a “Y” where your family
member is, and a “Z” for a second family member.
What do you need to do to think and act more dialectically?
87
What’s Typical for Adolescents
and What’s Cause for Concern?
Typical
Not Typical: Cause for Concern
1. Increased moodiness
Intense, painful, long-lasting moods; risky
mood-dependent behavior, major depression,
or panic attacks; self-injury or suicidal thinking
2. Increased selfconsciousness, of feeling “on
stage,” increased focus on
body image
Social phobia or withdrawal; perfectionism and
unrealistic standards; bingeing, purging, or
restricted eating; obsessive about or neglectful
of hygiene
3. Increased dawdling
Multiple distractions to point of not being able
to complete homework or projects, lack of
focus that interferes with daily work or tasks,
regularly late for appointments
4. Increased parent–
adolescent conflict
Verbal or physical aggression, running away
5. Experimentation with drugs,
alcohol, or cigarettes
Substance abuse, selling drugs, substanceusing peer group
6. Increased sense of
invulnerability (may lead to
increased sensation seeking
or risk taking)
Multiple accidents; encounters with firearms;
excessive risk taking (e.g., subway surfing,
driving drunk or texting while driving), getting
arrested
7. Stressful transitions to
middle and high school
School refusal; bullying or being bullied; lack of
connection to school or peers; school truancy,
failure, or dropout
8. Increased
argumentativeness,
idealism, and criticism;
being opinionated
Rebellious questioning of social rules and
conventions; causing trouble with family
members, teachers, or others who attempt to
assert authority over the adolescent
88
Validation
VALIDATION communicates to another person that his or her feelings, thoughts,
and actions make sense and are understandable to you in a particular situation.
SELF-VALIDATION involves perceiving your own feelings, thoughts, and actions
as making sense, accurate, and acceptable in a particular situation.
INVALIDATION communicates (intentionally or not, through words or actions)
that another person’s feelings, thoughts, and actions in a particular situation
make no sense, are “manipulative,” or “stupid,” or an “overreaction,” or not
worthy of your time, interest, or respect.
Remember: Validation ≠ Agreement
Validation does not necessarily mean that you like or agree with what the other
person is doing, saying, or feeling. It means that you understand where they are
coming from.
WHY VALIDATE?
• Validation improves relationships!!!!
• It can deescalate conflict and intense emotions.
• Validation can show that:
‰
We are listening.
‰
We understand.
‰
We are being nonjudgmental.
‰
We care about the relationship.
‰
We can disagree without having a big conflict.
WHAT TO VALIDATE?
• Feelings, thoughts, and behaviors in ourselves or others
Validate the valid, not the invalid. You can still validate the feeling without
validating the behavior. For example: Validate someone feeling upset about a low
test grade even though you know he or she didn’t study, but don’t validate the lack
of studying that led to the low grade.
89
Levels of Validation
1. Pay Attention
There are so many ways to be present. Often one of the reasons other people are uncomfortable with
intense emotion is that they don’t know what to say. Just being present, paying complete attention to
the person in a nonjudgmental way, is often the answer. For yourself, being mindful of your own
emotion is the first step to accepting your emotion.
Multi-tasking while you listen to another person is not being present. Being present means giving all
your attention to the person you are validating.
Being present for yourself means acknowledging your internal experience and sitting with it rather than
“running away” from it, avoiding it, or pushing it away. Sitting with intense emotion is not easy. Even
happiness or excitement can feel uncomfortable at times.
2. Reflect Back
Accurate reflection means you summarize what you have heard from someone else or summarize your
own feelings. This type of validation can be done by others in an awkward, sing-songy, artificial way that
is truly irritating or by yourself in a criticizing way. When done in an authentic manner, with the intent of
truly understanding the experience and not judging it, accurate reflection is validating.
Sometimes this type of validation helps someone sort through their thoughts and separate them from
their emotions. “So basically I’m feeling pretty angry and hurt,” would be a self-reflection. ”Sounds like
you’re disappointed in yourself because you didn’t call him back,” could be accurate reflection by
someone else.
Monitor judgmental language or tone of voice
3. “Read Minds”
Reading a person’s behavior and guessing what they might be feeling or thinking. Be sensitive to what is
not being said by the other person. Pay attention to facial expressions, body language, what is
happening, and what you know about the person already. Show you understand in words or by your
actions.
People vary in their ability to know their own feelings. For example, some confuse anxiety and
excitement and some confuse excitement and happiness. Some may not be clear about what they are
feeling because they weren’t allowed to experience their feelings or learned to be afraid of their feelings.
Often, people mask their feelings because they have learned that others don’t react well to them. This
masking can lead to not acknowledging their feelings even to themselves, which makes the emotions
more difficult to manage. Being able to accurately label feelings is an important step to being able to
regulate them.
89.1
When someone is describing a situation, notice the emotional state. Then either label the emotions you
hear or guess at what the person might be feeling.
“I’m guessing you must have felt pretty hurt by her comment” is Level Three validation. Remember that
you may guess wrong and the person could correct you. It’s their emotion, so they are the only one who
knows how they feels. Check it out and make sure you are right; let it go if you are not.
4. Understand
Look for how what the other person is feeling, thinking, or doing makes sense, based on the person’s
past experiences, present situation, and/or current state of mind or physical conditions (the causes)
Your experiences and biology influence your emotional reactions. If your best friend was bitten by a dog
a few years ago, she is not likely to enjoy playing with your German Shepherd. Validation at this level
would be saying, “Given what happened to you, I completely understand you not wanting to be around
my dog.”
Self-validation would be understanding your own reactions in the context of your past experiences.
How has this been “learned?”
5. Acknowledge the Valid
Look for how the person’s feelings, thinking, or actions are valid responses because they fit current facts,
or are understandable because they are logical responses to current facts.
Normalizing—anyone would have this emotional response
Understanding that your emotions are normal is helpful for everyone. For the emotionally sensitive
person, knowing that anyone would be upset in a specific situation is validating. For example, “Of course
you’re anxious. Speaking before an audience the first time is scary for anyone.”
6. Show Equality (Radical Genuineness)
Be yourself! Show up! Match!
Treat the other as an equal, not as fragile or incompetent.
Don’t “one-up” or “one-down” the other person.
Radical genuineness is sharing that experience as equals.
89.2
How Can We Validate Others?
1. Actively listen. Make eye contact and stay focused.
2. Be mindful of your verbal and nonverbal reactions in order to avoid invalidation
(e.g., rolling eyes, sucking teeth, heavy sighing, walking away, making light of
serious things, or saying, for example, “That’s stupid, don’t be sad,” “I don’t care
what you say,” “Whatever!”).
3. Observe what the other person is feeling in the moment. Look for a word that
describes the feeling.
4. Reflect the feeling back without judgment. The goal is to communicate that you
understand how the other person feels (e.g., “It makes sense that you’re angry”;
“I understand that you are having a tough time right now”).
For self-validation: “I have a right to feel sad.” Avoid “Yes, but . . . ” thinking.
Instead, think about what your best friend in Wise Mind would say to you.
5. Show tolerance! Look for how the feelings, thoughts, or actions make sense
given the other’s (or your own) history and current situation, even if you don’t
approve of the behavior, emotion, or action itself.
6. Respond in a way that shows that you are taking the person seriously (with or
without words); for example, “That sounds awful.” If someone is crying, give
a tissue or a hug. You may ask, “What do you need right now? For me to just
listen or to help you problem-solve?”
90
How Can We Validate Ourselves?
How can I validate myself?
1. Actively listen and pay attention to yourself: Be mindful of your thoughts,
feelings, and behaviors.
2. Describe your feelings without passing judgment: “Wow, I’m really angry right
now!” or “It makes sense that I’m a little nervous.”
3. Respond in a way that shows that you take yourself seriously: Accept that it is
OK to have your emotion(s) (e.g., “It’s OK to feel sad sometimes”).
4. Acknowledge that the emotion may make sense in the situation. Show
tolerance for yourself and your emotions (e.g., “It makes sense that I’m not able
to focus very well with all of the stress I am under”).
5. Do not judge your own emotion (or yourself).
6. Use interpersonal effectiveness skills for self-respect to be fair to yourself, not
apologize for feeling how you feel, stick up for yourself, and stay true to your
values (FAST).
91
Self-Validation and Self-Respect
Due Date:
Name:
Week Starting:
Fill out this sheet whenever you practice your self-validation skills and whenever you have an opportunity to practice even if you don’t (or almost don’t) do anything to practice. Write on the back of this
sheet if you need more room.
List one self-invalidating and two self-validating statements you made.
1.
2.
3.
Describe a situation where you felt invalidated in the past week:
Check each strategy you used during the week:
‰‰
Checked all the facts to see if my responses are valid or invalid.
‰‰
Checked it out with someone I could trust to validate the valid.
‰‰
Acknowledged when my responses didn’t make sense and were not valid.
‰‰
Worked to change invalid thinking, comments, or actions. (Stopped blaming.)
‰‰
Dropped judgmental self-statements. (Practiced opposite action.)
‰‰
Reminded myself that all behavior is caused and that I am doing my best.
‰‰
Was compassionate toward myself. Practiced self-soothing.
‰‰
Admitted that it hurts to be invalidated by others, even if they are right.
‰‰
Acknowledged when my reactions make sense and are valid in a situation.
‰‰
Remembered that being invalidated, even when my response is actually valid, is rarely a
complete catastrophe.
‰‰
Described my experiences and actions in a supportive environment.
‰‰
Grieved traumatic invalidation in my life and the harm it has created.
‰‰
Practiced radical acceptance of the invalidating person(s) in my life.
‰‰
What was the outcome?
92
Recovering from Invalidation
NOTICE THAT INVALIDATION
CAN BE HELPFUL AND PAINFUL AT THE SAME TIME
Remember:
Invalidation Is Helpful When
1. It corrects important mistakes (your facts are wrong).
2. It stimulates intellectual and personal growth by listening
to other views.
3. Other:
Invalidation Is Painful When
1. You are being ignored.
2. You are not being repeatedly misunderstood.
3. You are being misread.
4. You are being misinterpreted.
5. Important facts in your life are ignored or denied.
6. You are receiving unequal treatment.
7. You are being disbelieved when being truthful.
8. Your private experiences are trivialized or denied.
9. Other:
93
Be Nondefensive and Check the Facts
Check ALL the facts to see if your responses are valid or invalid.
Check them out with someone you can trust to validate the valid.
Acknowledge when your responses don’t make sense and are not
valid.
Work to change invalid thinking, comments, or actions. (Also, stop
blaming. It rarely helps a situation.)
Drop judgmental self-statements. (Practice opposite action.)
Remind yourself that all behavior is caused and that you are doing
your best.
Be compassionate toward yourself. Practice self-soothing.
Admit that it hurts to be invalidated by others, even if they are right.
Acknowledge when your reactions make sense and are valid in a
situation.
Remember that being invalidated, even when your response is
actually valid, is rarely a complete catastrophe.
Describe your experiences and actions in a supportive environment.
Grieve traumatic invalidation and the harm it created.
Practice radical acceptance of the invalidating person.
Validate Yourself Exactly the Way You Would
Validate Someone Else
94
Behavior Change
Behavior change skills are strategies used to increase behaviors we want and to reduce
behaviors we don’t want (in ourselves and others).
BEHAVIORS TO INCREASE
Remember to be specific and measurable.
SELF:
What behaviors would you like to increase in yourself (e.g., exercising, saving money,
going to school, doing homework)?
OTHERS:
What behaviors would you like to increase in someone else (e.g., spending more time
with you, listening to you, making eye contact, putting dirty dishes in the sink)?
95
Behavior Change
BEHAVIORS TO DECREASE
SELF:
What behaviors would you like to decrease in yourself (e.g., overeating, cigarette
smoking, cutting, blurting out impulsively, arguing back, running away, fighting, skipping
classes, lying in bed during the day)?
OTHERS:
What behaviors would you like to decrease in someone else (e.g., nagging, breaking
curfew, running away, yelling, avoiding school, invalidation, playing videogames, staying up
past bedtime)?
96
Ways to Increase Behaviors
Reinforcers are consequences that result in an increase in a behavior. They
provide information to a person about what you want them to do.
• Positive reinforcement: Increases the frequency of a behavior by providing a
“rewarding” consequence.(e.g., labeled praise; a genuine compliment; an A on
an exam).
HINT: Timing is very important. Give the reward immediately and choose
motivating reinforcers! Don’t forget to reinforce yourself!
Examples:
• Negative reinforcement: Increases the frequency of a behavior by removing
something negative; it’s relief from something unpleasant.
Examples: Why take an aspirin when you have a headache? It relieves the
headache and that makes you more likely to take aspirin next time you have a
headache (aversive stimulus). Aspirin taking is negatively reinforced.
If your mom is nagging you, you are more likely to clean your room in order
to stop the nagging. If you have intense negative emotions, and a harmful
behavior provides temporary relief, you are more likely to repeat the harmful
behavior. Remember, you are learning skills to manage this better!
97
Ways to Increase Behaviors
Examples of negative reinforcements that are not harmful (e.g., positive ways to
soothe yourself, leaving painful situations):
• Shaping: Reinforcing small steps that lead toward the ultimate goal (e.g., going
from A to Z in 26 steps, each step rewarded).
Example: A teenager is anxious about going to school and doesn’t usually go.
She might be encouraged to go for 1 hour on Monday, 2 hours on Tuesday, and
so on, until she’s able to stay for a whole day, ultimately leading up to staying
every day, all week long. Reinforce each step!
98
Practice Exercise: Positive Reinforcement
Due Date
1. Look for opportunities (since they are occurring all of the time) to positively reinforce
yourself and someone else. First, simply notice or acknowledge something positive that
occurred (positive tracking).
What is something positive that you did this week?
What is something positive that your family member did this week?
2. Using a different example, identify a specific behavior you wanted to increase and the
reinforcer you used to help increase it. Remember, you can reinforce even a small step in
the right direction (shaping)!
A. For yourself:
Behavior:
Reinforcer:
B. Someone else:
Behavior:
Reinforcer:
3. Describe the situation(s) when you used reinforcement:
A. For yourself:
B. Someone else:
4. What was the outcome? What did you observe?
A. For yourself:
B. Someone else:
99
Ways to Decrease or Stop Behaviors
Extinction: Reduces a behavior by withholding previous reinforcement. When
attention is reinforcing, ignore the unwanted behavior. Make sure you reinforce a
desirable replacement behavior.
• If a parent ignores a child’s tantrum, the child will eventually stop tantruming.
• Beware of the behavioral burst, a temporary increase in the behavior you are
trying to extinguish. DON’T GIVE UP or forget to orient the person in whom you
are beginning to extinguish a particular behavior!
• Beware of intermittent reinforcement: Behavior that is reinforced only
occasionally is the hardest behavior to extinguish (e.g., never give candy to stop
a tantrum after you’ve ignored episodes).
Punishment: A consequence that results in a decrease in behavior. It tells another
person what you don’t want him or her to do. Use sparingly because:
• Punishment does not teach new behavior.
• Punishment can lead to resentment and a feeling of demoralization.
• Punishment may lead to self-punishment.
100
Ways to Decrease or Stop Behaviors
To use punishment effectively:
• First, reinforce desired behaviors to prevent undesired ones.
• Communicate clear rules and expectations.
• Have a menu of possible punishments ready in advance.
• Pair a negative consequence with reinforcement of desired behavior.
• Be specific, time limited, and make the punishment fit the crime (e.g., if you’re
out past curfew 1 hour, your curfew is 1 hour earlier next time).
• Ask yourself, is Wise Mind dictating the consequence?
• Apply the punishing consequence immediately or . . .
• Allow natural consequences (e.g., you failed the test because you stayed up all
night and were too tired to focus in school).
101
Practice Exercise: Extinction and Punishment
Extinction
Practice ignoring what peers or family members do that is annoying or provocative.
Important Note 1: Don’t use with behaviors that are dangerous!
Important Note 2: If provocative behaviors include bullying or pressuring you to do something
that goes against your values, ignoring (extinction) might not be enough. You may need to
tell a trusted authority figure and ask for help!
Briefly describe the situation and what you ignored. How did it work out?
Punishing Consequences: Use Sparingly or as Last Resort
Parents:
List three Wise Mind–based short-term consequences you can apply when other methods of
behavior change haven’t worked:
1.
2.
3.
102
EMOTION REGULATION
103
Taking Charge of Your Emotions: Why Bother?
Taking charge of your emotions is important because:
Adolescents often have intense emotions that are difficult to manage,
such as anger, shame, depression, or anxiety.
Difficulties controlling these emotions often lead to problematic
behaviors that affect you and those around you.
Problematic behaviors are often ineffective solutions to intensely
painful emotions.
104
Goals of Emotion Regulation Skills Training
I. Understand the emotions that you experience.
• Identify (observe and describe/name) emotions.
• Know what emotions do for you (are your emotions working
for or against you in this moment?).
II. Reduce emotional vulnerability and stop unwanted emotions
from starting in the first place.
• Increase positive emotions.
• Decrease vulnerability to Emotion Mind.
III. Decrease the frequency of unwanted emotions.
IV. Decrease emotional suffering; stop or reduce unwanted
emotions once they start.
• Let go of painful emotions using mindfulness.
• Change emotions through opposite action.
105
Short List of Emotions
Other names for emotions I frequently have:
106
What Good Are Emotions?
Emotions Give Us Information.
• Emotions provide us with a signal that
something is happening (e.g., “I feel nervous
standing alone in this dark alley”).
• Sometimes our emotions communicate by
“gut feeling” or intuition. This can be helpful if
our emotions get us to check out the facts.
• It’s a problem when we treat emotions as if
they are facts about the world. For example:
“If I am afraid, there must be a threat,” or “I
love him, so he must be good for me.”
• We need to be mindful that emotions are not facts.
Therefore, it is important to check the facts about
the situation.
Emotions Communicate to, and Influence, Others.
• Facial expressions, body posture, and voice tone say
a lot about how you’re feeling. They communicate
emotions to others (e.g., your sad face may cause
someone to ask you if you are OK and to give you
support).
• Whether you realize it or not, your emotions—
expressed by words, face, or body language—
influence how other people respond to you.
Emotions Motivate and Prepare Us for Action.
• The action urge connected to specific emotions is
often “hardwired.” For example, when we hear a
loud horn beep suddenly, we startle.
• Emotions save time in getting us to act in important
situations. Our nervous system activates us (e.g., we
instantly jump out of the way of an oncoming car).
We don’t have to think everything through.
• Strong emotions can help us overcome obstacles—
in our mind and in the environment.
107
108
Aftereffects
Secondary
Emotions
Prompting Event 2
Attention/Awareness
Prompting Event
Attention/Awareness
Interpretation
(Thoughts/beliefs about
prompting event)
Preexisting
Vulnerability Factors
Action urges
Body sensations (feelings)
Experiences
Nervous system changes
(internal body changes
that affect muscles
and autonomic system
firing—blood vessels,
heart rate, temperature)
Brain changes
(neural firing)
Biological Changes
Actions
(your behavior)
Words
(what you say)
Face and Body Language
(facial expression, posture,
gestures, skin color)
Expressions
Model for Describing Emotions
Awareness
Emotion
Name
109
Prompting Event 2
What happened next to trigger
more emotion firing?
Thoughts (thoughts, beliefs,
assumptions):
Prompting Event:
What triggered the emotion? What
happened in the minutes right before
the emotion fired? Just the facts!
Vulnerability Factors:
What happened before to make
me more vulnerable to the
prompting event?
Aftereffects (secondary emotions,
behavior, thoughts, etc.)
Action Urge
What do I feel like doing?
What do I want to say?
Intensity (0–100)
Emotion Name
Face and Body Change/Sensing
What am I feeling in my body?
Internal
External
Actions and Words
What I said and did:
Face and Body Language
What is my facial expression?
Posture? Gestures?
Due Date
Practice Exercise: Observe and Describe an Emotion
110
REDUCE EMOTIONAL PROMPTING EVENTS
Problem Solving
Prompting Event 2
CHANGE EMOTIONAL THOUGHTS
AND INTERPRETATIONS
Check the Facts
Thoughts
Prompting Event 1
REDUCE EMOTIONAL
VULNERABILITY
1. Accumulate Positive Emotions
2. Build Mastery
3. Cope Ahead
4. PLEASE skills
Vulnerability Factors
MANAGE AFTEREFFECTS
Repeat for Secondary Emotions
Distress Tolerance Skills
Aftereffects
Action
Urges
REDUCE EMOTIONAL REACTIONS
AND HIGH AROUSAL
Crisis Survival Strategies
Mindfulness of Current Emotions
Body Changes
what you experience
Internal
Describe Emotions
Emotion
Name
A Model of Emotions with Skills
Actions
what you say and do
CHANGE EMOTIONAL REACTIONS
Opposite Action
All the Way
Opposite Body Language
Opposite Words
Face and Body
(expression, body language,
posture)
External
Ways to Describe Emotions
anger
aggravation
agitation
annoyance
bitterness
exasperation
ferocity
frustration
ANGER WORDS
fury
grouchiness
grumpiness
hostility
indignation
irritation
outrage
rage
vengefulness
wrath
Prompting Events for Feeling Anger
• Not having things turn out as expected.
• Having an important goal blocked.
• Physical or emotional pain.
• You or someone you care about being
• Other:
attacked or threatened by others.
• Losing power, status, or respect.
Interpretations of Events That Prompt Feelings of Anger
• Rigidly thinking, “I’m right.”
• Believing that you have been treated unfairly.
• Judging that the situation is illegitimate or
• Blaming.
wrong.
• Believing that important goals are being
• Ruminating about the event that set off the
blocked or stopped.
anger in the first place.
• Believing that things “should” be different
• Other:
than they are.
•
•
•
•
•
Biological Changes and Experiences of Anger
• Being unable to stop tears.
Muscles tightening.
• Wanting to hit someone, bang the wall, throw
Teeth clamping together.
something, blow up.
Hands clenching.
• Wanting to hurt someone.
Feeling your face flush or get hot.
• Other:
Feeling like you are going to explode.
•
•
•
•
•
•
•
•
Expressions and Actions of Anger
• Clenching your hands or fists.
Physically or verbally attacking.
• Frowning, not smiling, mean expression.
Making aggressive or threatening gestures.
• Brooding or withdrawing from others.
Pounding, throwing things, breaking things.
• Crying.
Walking heavily, stomping, slamming doors.
• Grinning.
Walking out.
Using a loud, quarrelsome, or sarcastic voice. • A red or flushed face.
• Other:
Using obscenities or swearing.
Criticizing or complaining.
Aftereffects of Anger
• Imagining future situations that will make you
• Narrowing of attention.
angry.
• Attending only to the situation that’s making
• Depersonalization, dissociative experiences,
you angry.
numbness.
• Ruminating about the situation making you
• Other:
angry or about situations in the past.
111
disgust
abhorrence
antipathy
•
•
•
•
•
•
aversion
condescension
contempt
DISGUST WORDS
dislike
distaste
repugnance
derision
hate
repelled
disdain
loathing
repulsion
resentment
revolted
scorn
sickened
spite
vile
Prompting Events for Feeling Disgust
• Seeing blood; getting blood drawn.
Seeing/smelling human or animal waste
• Observing or hearing about a person acting
products.
with extreme hypocrisy/fawning.
Having a person or an animal that is dirty,
• Observing or hearing about betrayal, child
slimy, or unclean come close to you.
abuse, racism, or other types of cruelty.
Tasting something or being forced to swallow
• Being forced to watch something that deeply
something you really don’t want.
violates your own Wise Mind values.
Seeing or being near a dead body.
• Being confronted with someone who is
Touching items worn or owned by a stranger,
deeply violating your own Wise Mind values.
dead person, or disliked person.
• Being forced to engage in or watch unwanted
Observing or hearing about a person who
sexual contact.
grovels or who strips another person of
• Other:
dignity.
Interpretations of Events That Prompt Feelings of Disgust
another.
• Believing that:
• Extreme disapproval of yourself or your own
• You are swallowing something toxic.
feelings, thoughts, or behaviors.
• Your skin or your mind is being
• Judging that a person is deeply immoral or
contaminated.
has sinned or violated the natural order of
• Your own body or body parts are ugly.
things.
• Others are evil or the “scum” of the earth,
• Judging someone’s body as extremely ugly.
or that they disrespect authority or the
• Other:
group.
• Disapproving of/feeling morally superior to
•
•
•
•
•
•
•
•
•
•
•
•
•
Biological Changes and Experiences of Disgust
• Urge to take a shower.
Feelings of nausea; sick feeling.
• Urge to run away or push away.
Urge to vomit, vomiting, gagging, choking.
• Feeling contaminated, dirty, unclean.
Having a lump in your throat.
• Feeling mentally polluted.
Aversion to drinking or eating.
• Fainting.
Intense urge to destroy or get rid of
• Other:
something.
Expressions and Actions of Disgust
• Physically attacking causes of your disgust.
Vomiting, spitting out.
• Using obscenities or cursing.
Closing your eyes, looking away.
• Clenching your hands or fists.
Washing, scrubbing, taking a bath.
• Frowning, or not smiling.
Changing your clothes; cleaning spaces.
• Mean or unpleasant facial expression.
Avoiding eating or drinking.
• Speaking with a sarcastic voice tone.
Pushing or kicking away; running away.
• Nose and top lip tightened up; smirking.
Treating with disdain or disrespect.
• Other:
Stepping over; crowding another person out.
Aftereffects of Disgust
• Becoming hypersensitive to dirt.
• Narrowing of attention.
• Other:
• Ruminating about the situation that’s making
you feel disgusted.
112
envy
bitterness
covetous
craving
discontented
disgruntled
ENVY WORDS
displeased
dissatisfied
down-hearted
greed
“green-eyed”
longing
pettiness
resentment
wishful
Prompting Events for Feeling Envy
• Others get something you really want and
• Someone has something you really want or
you don’t get it.
need but don’t or can’t have.
• Being around people who have more than
• You are not part of the “in” crowd.
you have.
• Someone appears to have everything.
• Someone you are competing with is more
• You are alone while others are having fun.
successful than you in an area important to
• Someone else gets credit for what you’ve
you.
done.
• Other:
• Someone gets positive recognition for
something and you don’t.
Interpretations of Events That Prompt Feelings of Envy
mediocre in comparison to others whom you
• Thinking you deserve what others have.
want to be like.
• Thinking others have more than you.
• Comparing yourself to others who have more
• Thinking about how unfair it is that you have
than you.
such a bad lot in life compared to others.
• Comparing yourself to people who have
• Thinking you have been treated unfairly by
characteristics that you wish you had.
life.
• Thinking you are unappreciated.
• Thinking you are unlucky.
• Other:
• Thinking you are inferior, a failure, or
•
•
•
•
•
•
•
•
Biological Changes and Experiences of Envy
• Wanting the person or people you envy to
Muscles tightening.
lose what they have, to have bad luck, or to
Teeth clamping together, mouth tightening.
be hurt.
Feeling your face flush or get hot.
• Feeling pleasure when others experience
Feeling rigidity in your body.
failure or lose what they have.
Pain in the pit of the stomach.
• Feeling unhappy if another person
Having an urge to get even.
experiences some good luck.
Hating the other person.
• Feeling motivated to improve yourself.
Wanting to hurt the people you envy.
• Other:
Expressions and Actions of Envy
• Doing something to make the other person
• Doing everything you can to get what the
fail or lose what he or she has.
other person has.
• Saying mean things about the other person
• Working a lot harder than you were to get
or making the person look bad to others.
what you want.
• Trying to show the other person up, to look
• Trying to improve yourself and your situation.
better than the other person.
• Taking away or ruining what the other person
• Avoiding persons who have what you want.
has.
• Other:
• Attacking or criticizing the other person.
• Doing something to get even.
Aftereffects of Envy
appreciating things you have or things others
• Narrowing of attention.
do for you.
• Attending only to what others have that you
• Ruminating about what you don’t have.
don’t.
• Ruminating when others have had more than • Making resolutions to change.
• Other:
you.
• Discounting what you do have; not
113
fear
anxiety
apprehension
dread
edginess
fright
FEAR WORDS
horror
nervousness
hysteria
overwhelmed
jumpiness
panic
shock
tenseness
terror
uneasiness
worry
Prompting Events for Feeling Fear
• Silence.
• Having your life, your health, or your well• Being in a new or unfamiliar situation.
being threatened.
• Being alone (e.g., walking alone, being home
• Being in the same situation (or a similar one)
alone, living alone).
where you have been threatened or gotten
• Being in the dark.
hurt in the past, or where painful things have
• Being in crowds.
happened.
• Leaving your home.
• Flashbacks.
• Having to perform in front of others.
• Being in situations where you have seen
• Pursuing your dreams.
others threatened or be hurt.
• Other:
Interpretations of Events That Prompt Feelings of Fear
• Believing that:
• Believing that:
• You will not get help you want or need.
• You might die, or you are going to die.
• You might lose help you already have.
• You might be hurt or harmed.
• You might lose someone important.
• You might lose something valuable.
• You might lose something you want.
• Someone might reject, criticize, or dislike
• You are helpless or are losing a sense of
you.
control.
• You will embarrass yourself.
• You are incompetent or are losing mastery.
• Failure is possible; expecting to fail.
• Other:
•
•
•
•
•
•
Biological Changes and Experiences of Fear
• Feeling nauseated.
Breathlessness.
• Getting cold; feeling clammy.
Fast heartbeat.
• Feeling your hairs standing on end.
Choking sensation, lump in throat.
• Feeling of “butterflies” in stomach.
Muscles tensing, cramping.
• Wanting to run away or avoid things.
Clenching teeth.
• Other:
Urge to scream or call out.
•
•
•
•
•
•
•
•
•
Expressions and Actions of Fear
• Talking yourself out of doing what you fear.
Fleeing, running away.
• Freezing, or trying not to move.
Running or walking hurriedly.
• Crying or whimpering.
Hiding from or avoiding what you fear.
• Shaking, quivering, or trembling.
Engaging in nervous, fearful talk.
• A shaky or trembling voice.
Pleading or crying for help.
• Sweating or perspiring.
Talking less or becoming speechless.
• Diarrhea, vomiting.
Screaming or yelling.
• Hair erect.
Darting eyes or quickly looking around.
• Other:
Frozen stare.
Aftereffects of Fear
• Imagining the possibility of more loss or
• Narrowing of attention.
failure.
• Being hypervigilant to threat.
• Isolating yourself.
• Losing your ability to focus or becoming
• Ruminating about other threatening times.
disoriented or dazed.
• Other:
• Losing control.
114
HAPPINESS WORDS
happiness
joy
enjoyment
relief
amusement
enthrallment
hope
satisfaction
bliss
enthusiasm
jolliness
thrill
cheerfulness
euphoria
joviality
triumph
contentment
excitement
jubilation
zaniness
delight
exhilaration
optimism
zest
eagerness
gaiety
pleasure
zeal
ecstasy
gladness
pride
elation
glee
rapture
Prompting Events for Feeling Happiness
•
•
•
•
•
•
•
•
Receiving a wonderful surprise.
Reality exceeding your expectations.
Getting what you want.
Getting something you have worked hard for
or worried about.
Things turning out better than you thought
they would.
Being successful at a task.
Achieving a desirable outcome.
Receiving esteem, respect, or praise.
• Receiving love, liking, or affection.
• Being accepted by others.
• Belonging somewhere or with someone or a
group.
• Being with or in contact with people who love
or like you.
• Having very pleasurable sensations.
• Doing things that create or bring to mind
pleasurable sensations.
• Other:
Interpretations of Events That Prompt Feelings of Happiness
• Interpreting joyful events just as they are, without adding or subtracting.
• Other:
Biological Changes and Experiences of Happiness
•
•
•
•
•
Feeling excited.
Feeling physically energetic, active.
Feeling like giggling or laughing.
Feeling your face flush.
Feeling calm all the way through.
• Urge to keep doing what is associated with
happiness.
• Feeling at peace.
• Feeling open or expansive.
• Other:
Expressions and Actions of Happiness
•
•
•
•
•
•
Smiling.
Having a bright, glowing face.
Being bouncy or bubbly.
Communicating your good feelings.
Sharing the feeling.
Silliness.
•
•
•
•
•
•
Hugging people.
Jumping up and down.
Saying positive things.
Using an enthusiastic or excited voice.
Being talkative or talking a lot.
Other:
Aftereffects of Happiness
• Being courteous or friendly to others.
• Doing nice things for other people.
• Having a positive outlook; seeing the bright
side.
• Having a high threshold for worry or
annoyance.
• Remembering and imagining other times you
have felt joyful.
• Expecting to feel joyful in the future.
• Other:
115
jealous
cautious
clinging
clutching
defensive
mistrustful
JEALOUSY WORDS
fear of losing someone/
something
possessive
rivalrous
suspicious
self-protective
wary
watchful
Prompting Events for Feeling Jealous
• You are treated as unimportant by a person
• An important relationship is threatened or in
you want to be close to.
danger of being lost.
• Your partner tells you that he or she desires
• A potential competitor pays attention to
more time alone.
someone you love.
• Your partner appears to flirt with someone
• Someone:
else.
• Is threatening to take away important things
• A person you are romantically involved with
in your life.
looks at someone else.
• Goes out with the person you like.
• You find the person you love is having an
• Ignores you while talking to a friend of
affair with someone else.
yours.
• Other:
• Is more attractive, outgoing, or selfconfident than you.
Interpretations of Events That Prompt Feelings of Jealousy
• Believing that:
• Believing that:
• You were cheated.
• Your partner does not care for you any
• No one cares about you.
more.
• Your rival is possessive and competitive.
• You are nothing to your partner.
• Your rival is insecure.
• Your partner is going to leave you.
• Your rival is envious.
• Your partner is behaving inappropriately.
• Other:
• You don’t measure up to your peers.
• I deserve more than what you are receiving.
•
•
•
•
•
•
•
•
•
•
•
Biological Changes and Experiences of Jealousy
Breathlessness.
• Feelings of rejection.
Fast heartbeat.
• Needing to be in control.
Choking sensation, lump in throat.
• Feeling helpless.
Muscles tensing.
• Wanting to grasp or keep hold of what you
Teeth clenching.
have.
Becoming suspicious of others.
• Wanting to push away or eliminate your rival.
Having injured pride.
Expressions and Actions of Jealousy
Violent behavior or threats of violence toward • Interrogating the person; demanding
accounting of time or activities.
the person threatening to take something
• Collecting evidence of wrongdoings.
away.
• Clinging; enhanced dependency.
Attempting to control the freedom of the
• Increased or excessive demonstrations of
person you are afraid of losing.
love.
Verbal accusations of disloyalty or
• Other:
unfaithfulness.
Spying on the person.
Aftereffects of Jealousy
• Being hypervigilant to threats to your
• Narrowing of attention.
relationships.
• Seeing the worst in others.
• Becoming isolated or withdrawn.
• Being mistrustful across the board.
• Other:
116
LOVE WORDS
love
adoration
affection
arousal
attraction
caring
charmed
compassion
desire
enchantment
fondness
infatuation
kindness
liking
limerence
longing
lust
passion
sentimentality
sympathy
tenderness
warmth
Prompting Events for Feeling Love
• You spend a lot of time with a person.
• A person:
• You share a special experience with a
• Offers or gives you something you want,
person.
need, or desire.
• You have exceptionally good communication
• Does things you want or need.
with a person.
• Does things you particularly value or
• Other:
admire.
• Feeling physically attracted to someone.
• Being with someone you have fun with.
•
•
•
•
•
Interpretations of Events That Prompt Feelings of Love
Believing that a person loves, needs, or appreciates you.
Thinking that a person is physically attractive.
Judging a person’s personality as wonderful, pleasing, or attractive.
Believing that a person can be counted on, or will always be there for you.
Other:
Biological Changes and Experiences of Love
• When you are with or thinking about
• Wanting the best for a person.
someone:
• Wanting to give things to a person.
• Feeling excited and full of energy.
• Wanting to see and spend time with a person.
• Fast heartbeat.
• Wanting to spend your life with a person.
• Feeling self-confident.
• Wanting physical closeness or sex.
• Feeling invulnerable.
• Wanting emotional closeness.
• Feeling happy, joyful, or exuberant.
• Feeling warm, trusting, and secure.
• Feeling relaxed and calm.
•
•
•
•
•
•
•
•
•
•
Expressions and Actions of Love
• Smiling.
Saying “I love you.”
• Sharing time and experiences with someone.
Expressing positive feelings to a person.
• Doing things that the other person wants or
Eye contact, mutual gaze.
needs.
Touching, petting, hugging, holding, cuddling.
• Other:
Sexual activity.
Aftereffects of Love
• Remembering other people who have loved
Only seeing a person’s positive side.
you.
Feeling forgetful or distracted; daydreaming.
• Remembering other positive events.
Feeling openness and trust.
• Believing in yourself; believing you are
Feeling “alive,” capable.
wonderful, capable, competent.
Remembering other people you have loved.
• Other:
117
sadness
despair
grief
misery
agony
•
•
•
•
•
•
•
•
•
•
disappointment
homesickness
neglect
alienation
discontentment
SADNESS WORDS
pity
crushed
anguish
displeasure
dismay
insecurity
hurt
sorrow
rejection
defeat
distraught
disconnected
suffering
dejection
gloom
loneliness
unhappiness
depression
glumness
melancholy
alone
woe
Prompting Events for Feeling Sadness
• Being with someone else who is sad or in
Losing something or someone irretrievably.
pain.
The death of someone you love.
• Reading or hearing about other people’s
Things not being what you expected or
problems or troubles in the world.
wanted.
• Being alone, or feeling isolated or like an
Things being worse than you expected.
outsider.
Being separated from someone you care for.
• Thinking about everything you have not
Getting what you don’t want.
gotten.
Not getting what you have worked for.
• Thinking about your losses.
Not getting what you believe you need in life.
• Thinking about missing someone.
Being rejected, disapproved of, or excluded.
• Other:
Discovering that you are powerless or
helpless.
Interpretations of Events That Prompt Feelings of Sadness
• Believing that a separation from someone will • Seeing things or your life as hopeless.
• Believing that you are worthless or not
last for a long time or will never end.
valuable.
• Believing that you will not get what you want
• Other:
or need in your life.
Biological Changes and Experiences of Sadness
ever start crying you will never be able to
• Feeling tired, run down, or low in energy.
stop.
• Feeling lethargic, listless; wanting to stay in
• Difficulty swallowing.
bed all day.
• Feeling as if nothing is pleasurable any more. • Breathlessness.
• Dizziness.
• Pain or hollowness in your chest or gut.
• Other:
• Feeling empty.
• Feeling as if you can’t stop crying, or if you
Expressions and Actions of Sadness
• Saying sad things.
• Avoiding things.
• Talking little or not at all.
• Acting helpless; staying in bed; being
• Using a quiet, slow, or monotonous voice.
inactive.
• Eyes drooping.
• Moping, brooding, or acting moody.
• Frowning, not smiling.
• Making slow, shuffling movements.
• Posture slumping.
• Withdrawing from social contact.
• Avoiding activities that used to bring pleasure. • Sobbing, crying, whimpering.
• Other:
• Giving up and no longer trying to improve.
•
•
•
•
•
Aftereffects of Sadness
• Ruminating about sad events in the past.
Not being able to remember happy things.
• Insomnia.
Feeling irritable, touchy, or grouchy.
• Appetite disturbance, indigestion.
Yearning and searching for the thing lost.
• Other:
Having a negative outlook.
Blaming or criticizing yourself.
118
shame
contrition
culpability
discomposure
SHAME WORDS
embarrassment
humiliation
mortification
self-conscious
shyness
Prompting Events for Feeling Shame
• Being reminded of something wrong,
• Being rejected by people you care about.
immoral, or “shameful” you did in the past.
• Having others find out that you have done
• Being rejected or criticized for something you
something wrong.
expected praise for.
• Doing (or feeling or thinking) something
• Having emotions/experiences that have been
that people you admire believe is wrong or
invalidated.
immoral.
• Exposure of a very private aspect of yourself
• Comparing some aspect of yourself or your
or your life.
behavior to a standard and feeling as if you
• Exposure of a physical characteristic you
do not live up to that standard.
dislike.
• Being betrayed by a person you love.
• Failing at something you feel you are (or
• Being laughed at/made fun of.
should be) competent to do.
• Being criticized in public/in front of someone
• Other:
else; remembering public criticism.
• Others attacking your integrity.
•
•
•
•
•
•
Interpretations of Events That Prompt Feelings of Shame
• Thinking that you are a bad person or a
Believing that others will reject you (or have
failure.
rejected you).
• Believing your body (or a body part) is too
Judging yourself to be inferior, not “good
big, too small, or ugly.
enough,” not as good as others; self• Thinking that you have not lived up to others’
invalidation.
expectations of you.
Comparing yourself to others and thinking
• Thinking that your behavior, thoughts, or
that you are a “loser.”
feelings are silly or stupid.
Believing yourself unlovable.
Thinking that you are bad, immoral, or wrong. • Other:
Thinking that you are defective.
Biological Changes and Experiences of Shame
• Wanting to hide or cover your face and body.
• Pain in the pit of the stomach.
• Other:
• Sense of dread.
• Wanting to shrink down and/or disappear.
•
•
•
•
•
•
Expressions and Actions of Shame
Hiding behavior or a characteristic from other • Appeasing; saying you are sorry over and
over and over.
people.
• Looking down and away from others.
Avoiding the person you have harmed.
• Sinking back; slumped and rigid posture.
Avoiding persons who have criticized you.
• Halting speech; lowered volume while talking.
Avoiding yourself— distracting, ignoring.
• Other:
Withdrawing; covering the face.
Bowing your head, groveling.
Aftereffects of Shame
numbness, or shock.
• Avoiding thinking about your transgression;
• Attacking or blaming others.
shutting down; blocking all emotions.
• Conflicts with other people.
• Engaging in distracting, impulsive behaviors
• Isolation, feeling alienated.
to divert your mind or attention.
• Impairment in problem-solving ability.
• High amount of “self-focus”; preoccupation
• Other:
with yourself.
• Depersonalization, dissociative experiences,
119
GUILT WORDS
guilt
culpability
remorse
apologetic
regret
sorry
Prompting Events for Feeling Guilt
• Doing or thinking something you believe is
wrong.
• Doing or thinking something that violates your
personal values.
• Not doing something you said that you would
do.
• Committing a transgression against another
person or something you value.
• Causing harm/damage to another person or
object.
• Causing harm/damage to yourself.
• Being reminded of something wrong you did
in the past.
• Other:
Interpretations of Events That Prompt Feelings of Guilt
• Thinking that your actions are to blame for
something.
• Thinking that you behaved badly.
• Thinking, “If only I had done something
differently . . . ”
• Other:
Biological Changes and Experiences of Guilt
• Hot, red face.
• Jitteriness, nervousness.
• Suffocating.
• Other:
Expressions and Actions of Guilt
• Trying to repair the harm, make amends for the wrongdoing, fix the damage, change the
outcome.
• Asking for forgiveness, apologizing, confessing.
• Giving gifts/making sacrifices to try to make up for the transgression.
• Bowing your head; kneeling before the person.
Aftereffects of Guilt
•
•
•
•
Making resolutions to change.
Making changes in behavior.
Joining self-help programs.
Other:
Other Important Emotion Words
•
•
•
•
•
•
•
•
•
Weariness, dissatisfaction, disinclination.
Distress.
Shyness, fragility, reserve, bashfulness, coyness, reticence.
Cautiousness, reluctance, suspiciousness, caginess, wariness.
Surprise, amazement, astonishment, awe, startle, wonder.
Boldness, bravery, courage, determination.
Powerfulness, a sense of competence, capability, mastery.
Dubiousness, skepticism, doubtfulness.
Apathy, boredom, dullness, ennui, fidgetiness, impatience, indifference, listlessness.
120
Overview:
Changing Emotional Responses
CHECK THE FACTS
Check out whether your emotional reactions fit the facts
of the situation.
Changing your beliefs and assumptions to fit the facts can help
you change your emotional reactions to situations.
OPPOSITE ACTION
When your emotions do not fit the facts,
or when acting on your emotions is not effective,
acting opposite (all the way)
will change your emotional reactions.
PROBLEM SOLVING
When the facts themselves are the problem,
solving the problem
will reduce the frequency of negative emotions.
121
Check the Facts and Problem Solving
These two skills can be used as part of Cope Ahead, or as independent emotion regulation
skills to help reduce/change intense emotions regarding situations that have already
occurred or are ongoing.
1. DESCRIBE the problem situation.
2. CHECK THE FACTS! (Check all the facts; sort them from interpretations.)
a. Are you interpreting the situation correctly? Are there other possible interpretations?
b. Are you thinking in extremes (all-or-nothing, catastrophic thinking?)
c. What is the probability of the worst happening?
d. Even if the worst were to happen, could you imagine coping well with it?
e. If you are still faced with a big problem, then start the steps below.
3. IDENTIFY your GOAL in solving the problem.
a. Identify what needs to happen or change for you to feel OK.
b. Keep it simple; keep it something that can actually happen.
4. BRAINSTORM lots of solutions.
a. Think of as many solutions as you can. Ask for suggestions from people you trust.
b. Do not be critical of any ideas at first (wait for Step 5 to evaluate ideas).
5. CHOOSE a solution that is likely to work.
a. If unsure, choose two or three solutions that look good.
b. Do pros and cons to compare the solutions. Choose the best to try first.
6. Put the solution into ACTION.
a. ACT: Try out the solution.
b. Take the first step, and then the second . . .
7. EVALUATE outcomes.
a. Did it work? YEAH! Reward yourself!
b. It didn’t work? Reward yourself for trying and DON’T GIVE UP!
c. Try a new solution.
122
Opposite Action and Problem Solving:
Deciding Which to Use
Opposite action = Acting opposite to an emotion’s action urge
Problem solving = Avoiding or changing (solving) a problem event
Ask:
Does this emotion
fit the facts?
Check the facts
Yes
No
Ask:
Is acting on this
emotion effective?
Ask:
Is acting on this
emotion effective?
Check Wise Mind
Check Wise Mind
Yes
Be mindful
of current
emotions
(Emotion Regulation
Handout 22)
Act on
emotion/
action urge
No
No
Yes
Do not act on
emotion/
action urge
Do not act on
emotion/
action urge
Consider
opposite action
(Emotion
Regulation
Handouts 10–11)
Change thoughts
to fit the facts
(Emotion
Regulation
Handout 8)
Be mindful
of current
emotions
(Emotion
Regulation
Handout 22)
Problem-solve
unwanted
emotions
(Emotion Regulation
Handout 12)
Do
opposite action
(Emotion
Regulation
Handouts 10–11)
123
Act, but
accept the
consequences
gracefully
Reconsider
opposite
action
Opposite Action
Use opposite action when your emotions do NOT fit the facts
or when acting on your emotions is NOT effective.
EVERY EMOTION HAS AN ACTION URGE.
CHANGE THE EMOTION BY ACTING OPPOSITE TO ITS ACTION URGE.
Consider these examples:
EMOTION
ACTION URGE
OPPOSITE ACTION
Fear
Run away/avoid
Approach/don’t avoid
Anger
Attack
Gently avoid/be a little nice
Sadness
Withdraw/isolate
Get active
Shame
Hide/avoid
Tell the secret to people who will accept it
HOW TO DO OPPOSITE ACTION, STEP BY STEP
Step 1. IDENTIFY AND NAME THE EMOTION you want to change.
Step 2. CHECK THE FACTS to see if your emotion is justified by the facts.
Check also whether the intensity and duration of the emotion fit the facts.
(Example: “Irritation” fits the facts when your car is cut in front of; “road rage” does not.)
An emotion is justified when your emotion fits the facts.
Step 3. IDENTIFY AND DESCRIBE YOUR ACTION URGES.
Step 4. ASK WISE MIND: Is expression or acting on this emotion effective in this situation?
If your emotion does not fit the facts or if acting on your emotion is not effective:
Step 5. IDENTIFY OPPOSITE ACTIONS to your action urges.
Step 6. ACT OPPOSITE ALL THE WAY to your action urges.
Step 7. REPEAT ACTING OPPOSITE to your action urges until your emotion changes.
124
Figuring Out Opposite Actions
FEAR
Fear FITS THE FACTS of a situation whenever there is a THREAT to:
A. Your life or that of someone you care about.
B. Your health or that of someone you care about.
C. Your well-being or that of someone you care about.
D. Other example:
Follow these suggestions when your fear is NOT JUSTIFIED by the facts or NOT EFFECTIVE:
OPPOSITE ACTIONS for Fear
Do the OPPOSITE of your fearful action urges. For example:
1. Do what you are afraid of doing . . . OVER AND OVER.
2. APPROACH events, places, tasks, activities, and people you are afraid of.
3. Do things to give yourself a sense of CONTROL and MASTERY over your fears.
ALL-THE-WAY OPPOSITE ACTIONS for Fear
4. Keep your EYES AND EARS OPEN and focused on the feared event.
Look around slowly; explore.
5. Take in the information from the situation (i.e., notice that you are safe).
6. Change POSTURE AND KEEP A CONFIDENT VOICE TONE.
Keep your head and eyes up, and your shoulders back but relaxed.
Adopt an assertive body posture (e.g., knees apart, hands on hips, heels a bit out).
7. Change your BODY CHEMISTRY.
For example, do paced breathing by breathing in deeply and breathing out slowly.
125
ANGER
Anger FITS THE FACTS of a situation whenever:
A. An important goal is blocked or a desired activity is interrupted or prevented.
B. You or someone you care about is attacked or hurt by others.
C. You or someone you care about is insulted or threatened by others.
D. The integrity or status of your social group is offended or threatened.
E. Other example:
Follow these suggestions when your anger is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:
OPPOSITE ACTIONS for Anger
Do the OPPOSITE of your angry action urges. For example:
1. GENTLY AVOID the person you are angry with (rather than attacking).
2. TAKE A TIME OUT, and breathe in and out deeply and slowly.
3. BE KIND (rather than mean or insulting).
ALL-THE-WAY OPPOSITE ACTIONS for Anger
4. IMAGINE UNDERSTANDING and empathy for the other person.
Step into the other person’s shoes. Try to see the situation from the other person’s
point of view.
Imagine really good reasons for what has happened.
5. CHANGE YOUR POSTURE.
Unclench hands, with palms up and fingers relaxed (WILLING HANDS).
Relax chest and stomach muscles.
Unclench teeth.
Relax facial muscles. Half-smile.
6. CHANGE YOUR BODY CHEMISTRY.
For example, do paced breathing by breathing in deeply and breathing out slowly.
Or, run or engage in another physically energetic, nonviolent activity.
126
DISGUST
Disgust FITS THE FACTS of a situation whenever:
A. Something you are in contact with could poison or contaminate you.
B. Somebody whom you deeply dislike is touching you or someone you care about.
C. You are around a person or group whose behavior or thinking could seriously damage
or harmfully influence you or the group you are part of.
D. Other example:
Follow these suggestions when your disgust is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:
OPPOSITE ACTIONS for Disgust
Do the OPPOSITE of your disgusted action urges. For example:
1. MOVE CLOSE. Eat, drink, stand near, or embrace what you found disgusting.
2. Be KIND to those you feel contempt for; step into the other person’s shoes.
ALL-THE-WAY OPPOSITE ACTIONS for Disgust
3. IMAGINE UNDERSTANDING and empathy for the person you feel disgust or contempt for.
Try to see the situation from the other person’s point of view.
Imagine really good reasons for how the other person is behaving or looking.
4. TAKE IN what feels repulsive.
Be sensual (inhaling, looking at, touching, listening, tasting).
5. CHANGE YOUR POSTURE.
Unclench hands with palms up and fingers relaxed (willing hands).
Relax chest and stomach muscles.
Unclench teeth.
Relax facial muscles.
Half-smile.
6. CHANGE YOUR BODY CHEMISTRY.
For example, do paced breathing by breathing in deeply and breathing out slowly.
127
ENVY
Envy FITS THE FACTS of a situation whenever:
A. Another person or group has what you want or need but don’t have.
B. Other example:
Follow these suggestions when your envy is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:
OPPOSITE ACTIONS for Envy
Do the OPPOSITE of your envious action urges. For example:
1. INHIBIT DESTROYING what the other person has.
2. COUNT YOUR BLESSINGS. Make a list of the things you are thankful for.
ALL-THE-WAY OPPOSITE ACTIONS for Envy
3. COUNT ALL your blessings.
Avoid discounting some blessings.
Avoid exaggerating your deprivations.
4. Stop EXAGGERATING others’ net worth or value; check the facts.
5. CHANGE YOUR POSTURE.
Unclench hands with palms up and fingers relaxed (WILLING HANDS).
Relax chest and stomach muscles.
Unclench teeth.
Relax facial muscles.
Half-smile.
6. CHANGE YOUR BODY CHEMISTRY.
For example, do paced breathing by breathing in deeply and breathing out slowly.
128
JEALOUSY
Jealousy FITS THE FACTS of a situation whenever:
A. Someone is threatening to take a very important and desired relationship or object away
from you.
B. An important and desired relationship is in danger of being damaged or lost.
C. Other example:
Follow these suggestions when your jealousy is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:
OPPOSITE ACTIONS for Jealousy
Do the OPPOSITE of your jealous action urges. For example:
1. LET GO of controlling others’ actions.
2. SHARE the things and people you have in your life.
ALL-THE-WAY OPPOSITE ACTIONS for Jealousy
3. STOP SPYING or snooping.
Suppress probing questions (“Where were you? Who were you with?”).
Fire your “private detective.”
4. NO AVOIDING. Listen to all the details. Focus on sensations.
Keep your eyes open; look around.
Take in all the information about the situation.
5. CHANGE YOUR POSTURE.
Unclench hands with palms up and fingers relaxed (WILLING HANDS).
Relax chest and stomach muscles.
Unclench teeth.
Relax facial muscles.
Half-smile.
6. CHANGE YOUR BODY CHEMISTRY.
For example, do paced breathing by breathing in deeply and breathing out slowly.
129
LOVE
Love (other than universal love for all) FITS THE FACTS of a situation whenever:
A. Loving a person, animal, or object enhances quality of life for you or for those you care
about.
B. Loving a person, animal, or object increases your chances of attaining your own
personal goals.
C. Other example:
Follow these suggestions when your love is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:
OPPOSITE ACTIONS for Love
Do the OPPOSITE of your loving action urges. For example:
1. AVOID the person, animal, or object you love.
2. DISTRACT yourself from thoughts of the person, animal, or object.
3. REMIND yourself of why love is not justified (rehearse the “cons” of loving) when loving
thoughts do arise.
ALL-THE-WAY OPPOSITE ACTIONS for Love
4. AVOID CONTACT with everything that reminds you of a person you love: pictures, letters/
messages/e-mails, belongings, mementos, places you were together, places you planned
to or wanted to go together, places where you know the person has been or will be. No
following, waiting for, or looking for the person.
5. STOP EXPRESSING LOVE for the person, even to friends. Be unfriendly toward the person
(e.g., “unfriend” the person on Facebook, Twitter, etc.).
6. ADJUST YOUR POSTURE AND EXPRESSIONS if you are around the person you love.
No leaning toward him or her.
No getting close enough to touch.
No sighing/gazing at the person.
130
SADNESS
Sadness FITS THE FACTS of a situation whenever:
A. You have lost something or someone permanently.
B. Things are not the way you want or expected and hoped them to be.
C. Other example:
Follow these suggestions when sadness is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:
OPPOSITE ACTIONS for Sadness
Do the OPPOSITE of your sad action (or inaction) urges. For example:
1. Get ACTIVE; approach.
2. AVOID AVOIDING.
3. BUILD MASTERY: Do things that make you feel competent and self-confident.
(See Emotion Regulation
: Build Mastery and Cope Ahead.)
4. Increase PLEASANT EVENTS.
ALL-THE-WAY OPPOSITE ACTIONS for Sadness
5. Pay attention to the PRESENT MOMENT!
Be mindful of your environment—each detail as it unfolds.
Experience new or positive activities you are engaging in.
6. CHANGE YOUR POSTURE (adopt a “bright” body posture, with head up, eyes open, and
shoulders back).
Keep an upbeat voice tone.
7. CHANGE YOUR BODY CHEMISTRY.
For example, increase physical movement (run, jog, walk, or do other active exercise).
131
SHAME
Shame FITS THE FACTS of a situation whenever:
A. You will be rejected by a person or group you care about if your personal characteristics
or behavior are made public.
B. Other example:
Follow these suggestions when both shame and guilt
are NOT JUSTIFIED by the facts or are NOT EFFECTIVE:
⎧ OPPOSITE ACTIONS for Shame
⎪
⎪ Do the OPPOSITE of your action urges. For example:
⎪
⎪
1. MAKE PUBLIC your personal characteristics or your behavior (with people who won’t
⎪
reject you).
⎪
⎪
2. REPEAT the behavior that sets off shame over and over (without hiding the behavior from
⎪
⎪
those who won’t reject you).
⎨
⎪
⎪ ALL-THE-WAY OPPOSITE ACTIONS for Shame
⎪
⎪
3. NO APOLOGIZING or trying to make up for a perceived transgression.
⎪
⎪
4. TAKE IN all the information from the situation.
⎪
⎪
5. CHANGE YOUR BODY POSTURE. Look innocent and proud. Lift your head; “puff up”
⎪
your chest; maintain eye contact. Keep your voice tone steady and clear.
⎩
Follow these suggestions when shame is NOT JUSTIFIED by the facts or is NOT EFFECTIVE, but
GUILT IS JUSTIFIED (your behavior does violate your own moral values):
⎧ OPPOSITE ACTIONS for Shame
⎪
⎪ Do the OPPOSITE of your action urges. For example:
⎪
⎪
1. MAKE PUBLIC your behavior (with people who won’t reject you).
⎪
⎪
2. APOLOGIZE for your behavior.
⎪
⎪
3. REPAIR the transgressions, or work to prevent or repair similar harm for others.
⎪
⎨
4. COMMIT to avoiding that mistake in the future.
⎪
⎪
5. ACCEPT the consequences gracefully.
⎪
⎪
⎪ ALL-THE-WAY OPPOSITE ACTIONS for Shame
⎪
⎪
6. FORGIVE yourself. Acknowledge the causes of your behavior.
⎪
⎪
7. LET IT GO.
⎩
132
GUILT
Guilt FITS THE FACTS of a situation whenever:
A. Your behavior violates your own values or moral code.
B. Other example:
Follow these suggestions when both guilt and shame
are NOT JUSTIFIED by the facts or are NOT EFFECTIVE:
⎧ OPPOSITE ACTIONS for Guilt
⎪
⎪ Do the OPPOSITE of your action urges. For example:
⎪
⎪
1. MAKE PUBLIC your personal characteristics or your behavior (with people who won’t
⎪
reject you).
⎪
⎪
⎪
2. REPEAT the behavior that sets off guilt over and over (without hiding the behavior from
⎪
those who won’t reject you).
⎪
⎨
⎪ ALL-THE-WAY OPPOSITE ACTIONS for Guilt
⎪
⎪
3. NO APOLOGIZING or trying to make up for a perceived transgression.
⎪
⎪
4. TAKE IN all the information from the situation.
⎪
⎪
5. CHANGE YOUR BODY POSTURE. Look innocent and proud. Lift your head; “puff up”
⎪
⎪
your chest; maintain eye contact. Keep your voice tone steady and clear.
⎪
⎩
Follow these suggestions when guilt is NOT JUSTIFIED by the facts or is NOT EFFECTIVE
but SHAME IS JUSTIFIED (you will be rejected by people you care about if found out):
⎧ OPPOSITE ACTIONS for Guilt
⎪
⎪
1. HIDE your behavior (if you want to stay in the group).
⎪
⎪
2. USE INTERPERSONAL SKILLS (if you want to stay in the group).
⎪
⎪
3. WORK TO CHANGE the person’s or group’s values.
⎪
⎨
4. JOIN A NEW GROUP that fits your values (and will not reject you).
⎪
⎪
5. REPEAT the behavior that sets off guilt over and over with your new group.
⎪
⎪
⎪ ALL-THE-WAY OPPOSITE ACTIONS for Guilt
⎪
⎪
6. VALIDATE YOURSELF.
⎩
133
Reviewing Opposite Action and Problem Solving
Justifying Events
Your life is in danger.
Fear
Your health is in danger.
Your well-being is in
danger.
Act Opposite
to Emotion Urge
(for Unjustified Emotion)
Do what you are afraid
of doing . . . over and
over.
Approach what you are
afraid of.
Do what gives you a
sense of control and
mastery.
Anger
A An important goal is
blocked or a desired
activity is interrupted or
prevented.
You or someone you
care about is attacked
or hurt (physically or
emotionally) by others.
You or someone
you care about is
insulted, offended, or
threatened by others.
Disgust
A Something you are
in contact with could
poison or contaminate
you.
You are close to a
person or group whose
actions or thinking
could seriously damage
or harm you or the
group you are part of.
Gently avoid.
Take a time out.
Do something kind.
Imagine understanding:
Step into the other
person’s shoes.
Imagine really good
reasons for what
happened.
Move close. Embrace.
Be kind; step into the
other person’s shoes.
Take in what feels
repulsive.
See the situation from
the other person’s point
of view.
134
Act on Emotion Urge,
Problem-Solve, or Avoid
(for Justified Emotion)
Freeze/run if danger is near.
Remove the threatening
event.
Do what gives you a sense of
control and mastery of the
fearful event.
Avoid the threatening event.
Fight back when being attacked,
if you have nothing to lose by
fighting.
Overcome obstacles to goals.
Work to stop further attacks,
insults, and threats.
Avoid or walk out on people who
are threatening.
Remove/clean up revolting
things.
Influence others to stop harmful
actions/stop things that
contaminate your community.
Avoid or push away harmful
people or things.
Imagine understanding a person
who has done disgusting things.
Envy
Jealousy
A. Loving a valued/
admired person, animal,
or object enhances the
quality of life for you or
those you care about.
B. Loving the person,
animal, or object
increases your chances
of attaining your own
personal goals.
Sadness
A. An important and
desired relationship or
object is in danger of
being damaged or lost.
B. Someone is
threatening to take
away an important and
desired relationship or
object.
Love
Justifying Events
A. Another person or
group gets or has
things you don’t have
that you want or need.
Act Opposite
to Emotion Urge
(for Unjustified Emotion)
1. Inhibit destroying other
people’s things.
2. Count your blessings.
3. Imagine how it all
makes sense.
4. Stop exaggerating
others’ worth or value.
1. Let go of trying to
control others.
2. Share what you have
with others.
3. Stop spying and
snooping.
4. No avoiding; take in all
the information.
1. Avoid the person,
animal, or object you
love altogether.
2. Distract yourself from
thoughts of the beloved.
3. Avoid contact with
all reminders of the
beloved.
4. Remind yourself of why
love is not justified.
A. You have lost
1. Activate your behavior.
something or someone 2. Avoid avoiding.
permanently.
3. Build mastery: Do
B. Things are not the
things that make you
way you expected or
feel competent and selfwanted or hoped for.
confident.
4. Increase pleasant
events.
5. Pay attention to
pleasant events.
135
1.
2.
3.
4.
5.
Act on Emotion Urge,
Problem-Solve, or Avoid
(for Justified Emotion)
Improve yourself and your life.
Get others to be fair.
Devalue what others have that
you don’t have.
Put on rose-colored glasses.
Avoid people who have more
than you.
1. Protect what you have.
2. Work at being more desirable to
the person(s) you want to be in
a relationship with (i.e., fight for
relationships).
3. Leave the relationship.
1. Be with the person, animal, or
thing that you love.
2. Touch, hold, etc., the beloved.
3. Avoid separations when
possible.
4. If the beloved is lost, fight to find
or get the beloved back (if it may
be possible).
1. Grieve; have a memorial service;
visit the cemetery (but don’t build
a house at the cemetery).
2. Retrieve/replace what is lost.
3. Plan how to rebuild a life worth
living without the beloved or
expected outcomes in your life.
4. Accumulate positives.
5. Build mastery: Do things that
make you feel competent and
self-confident.
6. Communicate need for help.
7. Accept help offered.
8. Put on rose-colored glasses.
Act Opposite
to Emotion Urge
(for Unjustified Emotion)
Act on Emotion Urge,
Problem-Solve, or Avoid
(for Justified Emotion)
A. You will be rejected
by a very important
person or group if
characteristics of
yourself or of your
behavior are made
public.
1. Make public your
personal characteristics
or behavior (with people
who won’t reject you).
2. Repeat the behavior
without hiding from
people who won’t reject
you.
3. Or, if your moral code is
violated, apologize and
repair; forgive yourself;
and let it go.
1. Hide what will get you rejected.
2. Appease those offended.
3. Change your behavior or
personal characteristics to fit in.
4. Avoid groups who disapprove
of you.
5. Find a new group that fits
your values or that likes your
personal characteristics.
6. Work to change society’s or a
person's values.
A. Your own behavior
violates your own
values or moral code.
1. Do what makes you feel 1. Seek forgiveness.
guilty over and over and 2. Repair the harm; make things
over.
better (or, if not possible, work
2. Make public your
to prevent or repair similar harm
behavior (with people
for others).
who won’t reject you).
3. Accept the consequences
gracefully.
Or, if you will be rejected
by others:
4. Commit to avoiding behaviors
that violate your moral values in
3. Hide your behavior.
the future.
4. Use interpersonal skills.
5. Work to change your
group’s values or join a
new group.
Guilt
Shame
Justifying Events
136
ABC PLEASE Overview
How to increase positive emotions
and
reduce vulnerability to Emotional Mind
Accumulating positive experiences
Build mastery
Cope ahead of time with emotional situations
Treat PhysicaL illness
Balance Eating
Avoid mood-altering drugs
Balance Sleep
Get Exercise
137
ACCUMULATING Positive Experiences—Short Term
(To Build a Dam between You and the Sea of Emotional Dyscontrol)
In the Short Term:
Do pleasant things that are possible right now.
• Increase pleasant activities that lead to
positive emotions.
• Do one thing each day from the Pleasant
Activities List. Also consider the Parent-Teen
Shared Pleasant Activities List.
• Be mindful of positive experiences.
Be Mindful of Positive Experiences:
• Focus your attention on positive events while
they are happening.
• Refocus your attention when your mind
wanders to the negative.
• Participate fully in the experience.
Be Unmindful of Worries:
• Don’t destroy positive experiences by
thinking about when they will end.
• Don’t think about whether you deserve this
positive experience.
• Don’t think about how much more might be
expected of you now.
138
Pleasant Activities List
1. Soaking in the bathtub
17. Going swimming
Going out to dinner
2. Thinking about how it will
be when school ends
18. Writing
Baking
19. Drawing or doodling
Planning a e e
someone
3. Going out with friends
4. Relaxing
5. Going to a movie
Playing sports
(list:
)
a i
6. Going running
22. Talking with friends
7. Listening to music
23. Working out
8. Lying in the sun (with
sunscreen)
24. Singing
9. Reading
10. Saving money
26. Going to a beach
11. Planning the future
27. Playing a musical
instrument
12. Dancing
28. Traveling
13. Fixing or cleaning things
around the house
29. Making a gift for
someone
14. Having a quiet night
30. Downloading music or
new apps
15. Cooking good food
16. Taking care of your pets
Buying clothes
Getting a haircut orstyling
your hair
Enjoying a cup of hot
chocolate, coffee, or tea
ei
25. Going ice skating
31. Watching sports on TV
139
for
affe i
ae
Going to hear live music
Getting a manicure or
pedicure
Spending some time with
little kids
Going for a bike ride
Going sledding in a
snowstorm
Getting a massage
(continued)
Pleasant Activities List (page 2 of 2)
45. E-mailing or texting
friends
lessons (sports, dance,
music, martial arts)
72. Figuring out your favorite
scent
46. Writing in a diary or
journal
Bowling
73. Buying yourself a little
treat
47. Looking at photos
48. Dressing up however you
like
is ali i
better
lifegetting
Saying “I love you”
49. Playing videogames
Writing a poem, song, or
rap
50. Walking around where
you live
Thinking about a friend’s
good qualities
51. Noticing birds or trees
(something in nature)
Putting on makeup
74. Noticing a storm coming
75. Building furniture or
carpentry
Add Your Own!
76.
52. Surfing the Internet
Making a smoothie and
drinking it slowly
53. Surprising someone with
a favor
Putting on your favorite
piece of clothing
54. Completing something
you will feel great about
Playing a game
55. Shooting pool or playing
ping-pong
Instant messaging
someone
79.
56. Contacting a relative with
whom you have been out
of touch
Watching reruns on TV
80.
57. Tweeting, posting online
77.
78.
Writing a story
Making a card and
giving it to someone you
care about
58. Thinking about taking
140
Parent–Teen Shared Pleasant Activities List
Instructions: Check off the activities on this list that you would enjoy doing with your parent/
teen. Then compare lists (or fill this out together) and select a few activities that you can enjoy
together—aim for at least 3 per week.
*Also, remember to respect each other’s need for privacy and alone time.
1. Going bicycling
13. Bowling
24. Having a barbecue
2. Going for coffee
14. Playing golf
25. Going camping
3. Going out for ice cream/
yogurt
15. Going for a drive
26. Listening to music you
both like
4. Cooking or baking
5. Getting a manicure
6. Going for a massage
7. Walking by the beach
8. Planning a vacation
9. Going shopping
16. Fixing up part of your
home
17. Doing a crossword
puzzle
18. Skiing, ice skating
19. Having some quiet
reading time together
10. Watching a ballgame
20. Going to a café/out to
eat
11. Doing yard work/
gardening
21. Going to an amusement
park
12. Playing with pets,
walking the dog
22. Going to a museum
23. Playing catch
141
27. Going to a show, game,
or concert
28. Watching a favorite TV
show or movie together
29. Going for a walk/run
30. Getting your hair or
makeup done together
31. Talking about when you
were little
32. Visiting relatives or
friends together
(continued)
Parent–Teen Shared Pleasant Activities List
33. Doing community
service/volunteer work
43. Talking about future
plans together
34. Shopping for a gift
44. Planning a surprise for
someone
35. Talking about your day
36. Playing videogames
37. Playing board games or
cards
38. Looking thru photos
39. Going to a park
40. Working out/going to the
gym
41. Take a yoga/exercise
class
42. Playing music/jamming
together
45. Joking around/being silly
46. Doing a creative hobby
together (e.g., painting,
drawing, knitting,
scrapbooking, model
building)
47. Taking an art class
48. Looking at/showing your
favorite website
49. Teaching the other one
something new (e.g., in
technology, photography)
50. Telling family stories
142
Add Your Own!
51.
52.
53.
54.
55.
Wise Mind Values and Priorities List
Mark the items that are important to you:
• Contribute (e.g., be generous, help people in need, make sacrifices for others, volunteer,
service to society).
• Attend to relationships (e.g., build new relationships, work on current relationships, repair
old relationships, end destructive relationships, treat others well).
• Be part of a group (e.g., be social, have close friends, have people to do things with, feel
sense of belonging).
• Build character (e.g., have integrity, be honest, be loyal, stand up for my beliefs, keep my
word, be respectful, be courageous in facing and living life, keep growing as a human
being).
• Be responsible (e.g., get my work done, earn money, take care of myself more and more,
be reliable).
• Achieve things (e.g., get good grades, work hard, be financially secure).
• Learn (e.g., seek knowledge and information, read, study).
• Have fun (e.g., enjoy what I do, laugh, go out and have a good time, relax).
• Focus on family (e.g., see family often, keep family relationships strong, do things for
family, respect family traditions).
• Be a leader (e.g., be seen by others as successful; be in charge of something like a club,
team, or committee; be respected by others; be accepted).
• Be healthy (e.g., be physically fit, exercise, eat and sleep well, see my doctors when
needed, practice yoga).
• Strive for moderation (e.g., avoid excesses and achieve balance).
• Other
143
ACCUMULATING Positive Experiences—Long Term
(To Build a Life Worth Living)
In the Long Term:
Make changes in your life so that positive events will occur more often. Build a life worth
living. Check “Wise Mind” Values and Priorities List.
Work toward goals based on your values:
• Identify one goal (e.g., graduate from high school).
• List small steps toward goals (e.g., get out of bed, go to first class).
• Take first step (e.g., buy an alarm clock or set cell phone alarm).
1. Goal:
2. Some steps toward my goal:
3. What’s a simple first step I can take?
Pay attention to relationships:
• Repair old, create new, work on current relationships, and end destructive
relationships.
What can I do this week to work on a relationship?
Avoid avoiding:
• Avoiding makes problems build up and increases vulnerability to Emotion Mind. Return
that call, schedule that doctor’s appointment, face that work, discuss that problem.
• Avoid giving up.
What have I been avoiding?
144
Building Mastery and Coping Ahead
BUILD MASTERY
1. Do at least one thing each day to feel competent and in control of your life. The idea is
to challenge yourself a little, get better at something, or cross something off your “todo” list. Examples: Put together a piece of furniture, practice your instrument, get one
HW assignment done, start a project.
Example:
2. Plan for success, not failure.
• Do something difficult, but possible.
3. Gradually increase the difficulty over time.
• If the first task is too difficult, do something a little easier next time.
COPE AHEAD OF TIME WITH EMOTIONAL SITUATIONS
Rehearse a plan ahead of time so that you are prepared when there is a threat.
1. Describe a situation that is likely to create negative emotions.
• Be specific in describing the situation. Check the facts!
• Name the emotions you are likely to experience in the situation.
2. Decide what DBT skills (including problem-solving) you want to use in the situation.
• Be specific. Write them out:
3. Imagine the situation in your mind as vividly as possible.
• Imagine yourself in the situation now.
4. Rehearse coping effectively in your mind.
• Rehearse exactly what you could do to cope effectively in your mind.
• Rehearse your actions, your thoughts, what you say, and how to say it.
• Troubleshoot: Rehearse coping with problems that might arise.
145
PLEASE Skills
Treat PhysicaL illness:
Take care of your body. See a doctor when
necessary. Take medications as prescribed.
Balance Eating:
Don’t eat too much or too little. Stay away from
foods that may make you overly emotional.
Avoid mood-altering
s s a es: a ff
es i e
s a al
l
ala e se PGDPGGFFBOEFOFSHZESJOLT
Balance Sleep:
Try to get the amount of sleep that helps you
feel rested. Stay on a regular schedule in order
to develop good sleep habits.
Get Exercise:
Do some sort of exercise every day, including
walking. Start small and build on it!
Exercise!
Eat healthy foods!
146
Get rest!
FOOD and Your MOOD
Step 1: Observe how certain foods affect your mood (both negatively and
positively).
Negative examples:
• Soda and sugary snacks might make you feel tired and irritable.
• Heavy, fatty foods (e.g., french fries, potato chips, fried chicken, greasy foods)
might make you feel sluggish.
• Caffeine might make you feel jittery and more anxious and interfere with your
sleep.
Positive examples:
• Complex carbohydrates and fiber (e.g., sweet potatoes, whole wheat pasta,
oatmeal, whole-grain cereals, salads) give you slow and steady energy.
• Proteins (e.g., lean meats and poultry, beans, nuts, fish, eggs) also provide your
body with steady energy that helps you stay active and strong both physically
and mentally.
• Dairy foods (e.g., low-fat milks, cheeses, yogurts) have protein and calcium,
which help with energy and bone strength.
• Fruits and vegetables provide you energy, boost your health, and give you a
sweet or crunchy treat without zapping your energy or making you feel guilty.
• Once you know what foods make up a balanced diet, you can determine what
changes might be needed.
Step 2: Notice whether you are eating too much or too little.
Step 3: Start thinking about changes.
How can you begin to increase the amount of healthy foods you eat? Keep track of
your food choices in a food diary every day so you see your progress!
(continued)
147
FOOD and Your MOOD
Step 4: Start small.
Don’t try to make dramatic changes to your diet all at once. You may feel
overwhelmed, which might set yourself up to fail. Start slowly and gradually to
change your habits.
For example:
• Cut down on processed foods and add more fresh foods.
• Add more fruits and vegetables to meals and have them for snacks.
• Add lettuce, tomato, cucumber, and onion to sandwiches.
• Add fruit to cereal.
Step 5: Notice the effects of eating well on your mood.
148
BEST Ways to Get REST: 12 Tips for Better Sleep
Maintaining a balanced sleep pattern will decrease your emotional vulnerability.
1. Stick to a schedule and don’t sleep late on weekends. If you sleep late on
Saturday and Sunday morning, you will disrupt your sleep pattern. Instead, go
to bed and get up at about the same time every day.
2. Establish a bedtime routine. This might include shutting off screens (TV,
computer, cell phone), changing into comfy PJs, sipping herbal tea, lowering
bright lights and reducing noise, and reading.
3. Don’t eat or drink a lot before bed. Eat a light dinner at least 2 hours before
sleeping. If you drink too many liquids before bed, you’ll wake up repeatedly
for trips to the bathroom. Watch out for spicy foods, which may cause
heartburn and interfere with sleep.
4. Avoid caffeine and nicotine. Both are stimulants and can keep you awake.
Caffeine should be avoided for 8 hours before your desired bedtime.
5. Exercise. If you’re trying to sleep better, the best time to exercise is in the
morning or afternoon. A program of regular physical activity enhances the
quality of your sleep.
6. Keep your room cool. Turn the temperature in the room down, as this
mimics the natural drop in your body’s temperature during sleep. Use an air
conditioner or a fan to keep the room cool. If you get cold, add more layers. If
you are hot, remove some layers.
7. Sleep primarily at night. Daytime naps steal hours from your nighttime sleep.
Limit daytime sleep to less than 1 hour, no later than 3:00 P.M.
8. Keep it dark, quiet, and NO SCREENS. Use shades, blinds, and turn off
lights. Silence helps you sleep better. Turn off the radio and TV. Use earplugs.
Use a fan, a white noise machine, or some other source of constant, soothing,
background noise to mask sounds you can’t control. No laptops, iPads,
phones, or screens for at least 1 hour before bedtime.
(continued)
149
BEST Ways to Get REST: 12 Tips for Better Sleep (page 2 of 2)
9. Use your bed only for sleep. Make your bed comfortable and appealing. Use
only for sleep—not for studying or watching TV. Go to bed when you feel tired
and turn out the lights. If you don’t fall asleep in 30 minutes, get up and do
something else relaxing like reading books or magazines—NO SCREENS! Go
back to bed when you are tired. Don’t stress out! This will make it harder to fall
asleep.
10. Soak and sack out. Taking a hot shower or bath before bed helps relax tense
muscles.
11. Don’t rely on sleeping pills. If they are prescribed to you, use them only under
a doctor’s close supervision. Make sure the pills won’t interact with other
medications!
12. Don’t catastrophize. Tell yourself “It’s OK; I’ll fall asleep eventually.”
150
The Wave Skill: Mindfulness of Current Emotions
•
•
•
•
•
•
EXPERIENCE YOUR EMOTION
Observe your feeling.
Step back and just notice it.
Get unstuck.
Experience it as a WAVE, coming and going.
Don’t try to GET RID of it or PUSH it away.
And don’t try to HOLD ON to it.
PRACTICE MINDFULNESS OF EMOTIONAL BODY SENSATIONS
• Notice WHERE in your body you are feeling emotional sensations.
• Experience the SENSATIONS as fully as you can.
REMEMBER: YOU ARE NOT YOUR EMOTION
• You don’t need to ACT on the feeling.
• Remember times when you have felt differently.
DON’T JUDGE YOUR EMOTION
• Radically accept it as part of you.
• Invite it home for dinner; name the emotion.
• Practice willingness to experience the emotion.
151
Mindfulness of Current Emotions
Due Date:
Name:
EMOTION NAME:
Week Starting:
INTENSITY (0–100) Before:
Describe situation that prompts emotion.
When emotional intensity is extreme, go to CRISISSURVIVAL SKILLS first
With any emotion, high or low, practice radical acceptance with M
FULNESS OF
CURRENT EMOTIONS.
Check off any of the following that you did:
‰‰
Stepped back and just noticed the emotions I was experiencing.
‰‰
Experienced the emotion as waves, coming and going on the beach.
‰‰
Let go of judgments about my emotions.
‰‰
Noticed where in my body I was feeling the emotional sensations.
‰‰
Paid attention to the physical sensations of the emotions as much as I could.
‰‰
Observed how long it took the emotion to go away.
‰‰
Reminded myself that being critical of emotions does not work.
‰‰
Practiced willingness to have unwelcome emotions.
‰‰
Imagined my emotions as clouds in the sky, coming and going.
‰‰
Just noticed the action urge that went with my emotion.
‰‰
Got myself to avoid acting on my emotion.
‰‰
Reminded myself of times when I have felt different.
‰‰
Practiced radically accepting my emotion.
‰‰
Tried to love my emotions.
Other:
Comments and descriptions of experiences:
152
After:
Managing Extreme Emotions
Follow these suggestions when emotional arousal is very HIGH—so extreme that your ability to
use your skills breaks down.
First, observe and describe that you are at your SKILLS BREAKDOWN POINT:
‰‰
Your distress is extreme.
‰‰
You are overwhelmed.
‰‰
You cannot focus your mind on anything but the emotion itself.
‰‰
Your mind shuts down; your brain stops processing information.
‰‰
You cannot solve problems or use complicated skills.
Now check the facts. Are you really “falling apart” at this level of distress?
If no, USE YOUR SKILLS.
If yes, go to Step 1: You are at your SKILLS BREAKDOWN POINT.
Step 1. Use crisis survival skills to bring down your arousal:
(See Distress Tolerance page 111.)
•
•
•
•
TIP your body chemistry.
DISTRACT yourself from the emotional events.
SELF-SOOTHE through the five senses.
IMPROVE the moment you are in.
Step 2. Return to mindfulness of current emotions.
Step 3. Try other emotion regulation skills (if needed).
153
What Makes It Hard to Regulate Your Emotions
BIOLOGY
‰‰
Biological factors can make emotion regulation harder.
LACK OF SKILL
‰‰
You don’t know what to do to regulate your emotions.
REINFORCEMENT OF EMOTIONAL BEHAVIOR
‰‰
Your environment reinforces you when you are highly emotional.
MOODINESS
‰‰
Your current mood controls what you do instead of your Wise Mind.
‰‰
You don’t really want to put in time and effort to regulate your emotions.
EMOTIONAL OVERLOAD
‰‰
High emotional arousal causes you to reach a skills breakdown point.
You can’t follow skills instructions or figure out what to do.
EMOTION MYTHS
‰‰
Myths (e.g., mistaken beliefs) about emotions get in the way of your
ability to regulate emotions.
‰‰
Myths that emotions are bad or weak lead to avoiding emotions.
‰‰
Myths that extreme emotions are necessary or are part of who you are
keep you from trying to regulate your emotions.
154
Myths about Emotions
1. There is a right way to feel in every situation.
Challenge:
2. Letting others know that I am feeling bad is a weakness.
Challenge:
3. Negative feelings are bad and destructive.
Challenge:
4. Being emotional means being out of control.
Challenge:
5. Some emotions are stupid.
Challenge:
6. All painful emotions are a result of a bad attitude.
Challenge:
7. If others don’t approve of my feelings, I obviously shouldn’t feel the way I do.
Challenge:
8. Other people are the best judges of how I am feeling.
Challenge:
9. Painful emotions are not important and should be ignored.
Challenge:
10. Extreme emotions get you a lot further than trying to regulate your emotions.
Challenge:
11. Creativity requires intense, often out-of-control emotions.
Challenge:
12. Drama is cool.
Challenge:
13. It is inauthentic to try to change my emotions.
Challenge:
14. Emotional truth is what counts, not factual truth.
Challenge:
15. People should do whatever they feel like doing.
Challenge:
16. Acting on your emotions is the mark of a truly free individual.
Challenge:
17. My emotions are who I am.
Challenge:
18. My emotions are why people love me.
Challenge:
19. Emotions can just happen for no reason.
Challenge:
20. Emotions should always be trusted.
Challenge:
21. Other myth:
Challenge:
155
Troubleshooting Emotion Regulation Skills: When What
You Are Doing Isn’t Working
CHECK YOUR BIOLOGICAL SENSITIVITY
1
• ASK: Am I biologically more vulnerable?
Do I have untreated physical illness or distress?
Am I out of balance on eating, use of drugs, sleep, exercise?
Have I taken medications as prescribed?
• WORK on your PLEASE skills.
1. Take care of physical illness and distress.
2. Take medications as prescribed. Check if others are needed.
3. Try again.
CHECK YOUR SKILLS
2
• REVIEW what you have tried.
Did you try a skill likely to be effective?
Did you follow the skill instructions to the letter?
• WORK on your skills.
1. Review and try other skills.
2. Get coaching if you need it.
3. Try again.
CHECK FOR REINFORCERS
3
• ASK: Do my emotions . . .
COMMUNICATE an important message or influence people to do things?
MOTIVATE me to do things I think are important?
VALIDATE my beliefs or my identity?
FEEL GOOD?
• IF YES:
1. Practice interpersonal effectiveness skills to communicate.
2. Work to find new reinforcers to motivate yourself.
3. Practice self-validation.
4. Do PROS AND CONS for changing emotions.
156
CHECK YOUR MOOD
4
• ASK: Am I putting in the time and effort that solving my problem will take?
• IF NO:
1. Do PROS AND CONS for working hard on skills.
2. Practice RADICAL ACCEPTANCE and WILLINGNESS skills.
3. Practice the mindfulness skills of PARTICIPATING and EFFECTIVENESS
(See Mindfulness
.)
CHECK FOR EMOTIONAL OVERLOAD
• ASK: Am I too upset to use complicated skills?
5
• IF YES, ask: Can the problems I am worrying about be easily solved now?
• IF YES, do PROBLEM SOLVING.(See Emotion Regulation
.)
IF NO, practice mindfulness of
• IF your emotions are too high for you to think
straight:
• Go to TIP skills.
(See Distress Tolerance
.)
CHECK FOR EMOTION MYTHS GETTING IN THE WAY
6
• CHECK FOR:
Judgmental myths about emotions (e.g., “Some emotions are stupid,” “There is a
right way to feel in every situation”)?
Beliefs that emotions and identity are the same (e.g., “My emotions are who I
am”)?
• IF YES:
1. Check the facts.
2. Challenge myths.
3. Practice thinking nonjudgmentally.
157
158
Accumulate positive emotions
Build mastery
Cope ahead
PLEASE skills
Distress Tolerance Skills
Repeat for Secondary Emotions
Manage Aftereffects
Distraction
Problem Solving
Reduce Emotional Prompting Events
Check the Facts
Change Emotional
Thoughts and Interpretations
1.
2.
3.
4.
Reduce Emotional Vulnerability
Mindfulness
of Current Emotions
Crisis Survival
Strategies
Reduce
Emotional Reactions
and
High Arousal
Review of Skills for Emotion Regulation
o
Opposite Words
Opposite
Body Language
Opposite Action
(all the way)
Change
Emotional Reactions
od
Describe Emotions
Name Emotions
otion
INTERPERSONAL EFFECTIVENESS
159
What Is Your Goal and Priority?
Keeping and maintaining healthy relationships (GIVE Skills)
Question: How do I want the other person to feel about me?
Example: If I care about the person or if the person has authority over
me, act in a way that keeps the person respecting and liking me.
Getting somebody to do what you want (DEAR MAN Skills)
Question: What do I want? What do I need? How do I get it?
How do I effectively say “no”?
Example: How do I ask for something, resolve a problem, or have
people take me seriously?
Maintaining Your Self-Respect (FAST Skills)
Question: How do I want to feel about myself after the interaction?
Example: What are my values? Act in a way that makes me feel positive
about myself.
160
What Stops You from Achieving Your Goals?
I. Lack of skill
You actually don’t know what to say or how to act.
II. Worry thoughts
You have the skill, but your worry thoughts interfere with your doing or saying
what you want.
• Worries about bad consequences:
‰
“They won’t like me”; “He will break up with me.”
• Worries about whether you deserve to get what you want:
‰
“I’m such a bad person, I don’t deserve this.”
• Worries about being ineffective and calling yourself names:
‰
“I won’t do it right”; “I’m such a loser.”
III. Emotions
You have the skill, but your emotions (anger, fear, shame, sadness) make you
unable to do or say what you want. Emotion Mind, instead of skills, controls
what you say and do.
IV. Can’t decide
You have the skills, but you can’t decide what you really want: asking for too
much versus not asking for anything; saying “no” to everything versus giving
in to everything.
7 Environment
You have the skill, but the environment gets in the way:
• Other people are too powerful (sometimes despite your best efforts).
• Other people may have some reason for not liking you if you get what you
want.
• Other people won’t give you what you need unless you sacrifice your selfrespect.
161
Myths in the Way of Interpersonal Effectiveness
Myths in the Way of Objectives Effectiveness
‰‰1. I don’t deserve to get what I want or need.
‰‰2. If I make a request, this will show that I am a very weak person.
‰‰3. I have to know whether a person is going to say yes before I make a request.
‰‰4. If I ask for something or say no, I can’t stand it if someone gets upset with me.
‰‰5. If they say no, it will kill me.
‰‰6. Making requests is a really pushy (bad, self-centered, selfish, etc.) thing to do.
‰‰7. Saying no to a request is always a selfish thing to do.
‰‰8. I should be willing to sacrifice my own needs for others.
‰‰9. I must be really inadequate if I can’t fix this myself.
‰‰
10. Obviously, the problem is just in my head. If I would just think differently I wouldn’t have to
bother everybody else.
‰‰
11. If I don’t have what I want or need, it doesn’t make any difference; I don’t care really.
‰‰
12. Skillfulness is a sign of weakness.
Other myth:
Other myth:
Myths in the Way of Relationship and Self-Respect Effectiveness
‰‰
13. I shouldn’t have to ask (say no); they should know what I want (and do it).
‰‰
14. They should have known that their behavior would hurt my feelings; I shouldn’t have to tell
them.
‰‰
15. I shouldn’t have to negotiate or work at getting what I want.
‰‰
16. Other people should be willing to do more for my needs.
‰‰
17. Other people should like, approve of, and support me.
‰‰
18. They don’t deserve my being skillful or treating them well.
‰‰
19. Getting what I want when I want it is most important.
‰‰
20. I shouldn’t be fair, kind, courteous, or respectful if others are not so toward me.
‰‰
21. Revenge will feel so good; it will be worth any negative consequences.
‰‰
22. Only wimps have values.
‰‰
23. Everybody lies.
‰‰
24. Getting what I want is more important than how I get it; the ends really do justify the means.
Other myth:
Other myth:
162
Worry Thoughts and Wise Mind Self-Statements
Turn negative thoughts into realistic ones.
1. Why bother asking? It won’t make a difference anyway.
WISE MIND STATEMENT:
2. If I ask for something, she’ll think I’m stupid.
WISE MIND STATEMENT:
3. I can’t take it if he’s [she’s] upset with me.
WISE MIND STATEMENT:
4. If I say “no,” they won’t like me or want to hang out with me anymore.
WISE MIND STATEMENT:
5. If I say “no,” they’ll be really angry at me.
WISE MIND STATEMENT:
6. If I make a request or ask for help, I will look weak.
WISE MIND STATEMENT:
Examples of Wise Mind Self-Statements:
1. “Just because I didn’t get what I wanted last time does not mean that if I ask skillfully this
time that I won’t get it.”
2. “I can handle it if I don’t get what I want or need.”
3. “It takes a strong person to admit that he [she] needs help from someone else and then
ask for it.”
4. “If I say ‘no’ to people and they get angry, it doesn’t mean I should have said ‘yes.’ ”
5. “I can deal with it if he [she] is annoyed with me.”
Others?
163
Building and Maintaining Positive Relationships:
GIVE Skills
Remember GIVE:
(be) Gentle
(act) Interested
Validate
(use an) Easy manner
(be) Gentle:
Be nice and respectful!
Don’t attack, use threats, or cast judgments.
Be aware of your tone of voice.
(act) Interested:
LISTEN and act interested in what the other person is saying.
Don’t interrupt or talk over him or her.
Don’t make faces.
Maintain good eye contact.
Validate:
(use an) Easy manner:
Show that you understand the other person’s feelings or opinions.
Be nonjudgmental out loud.
“I can understand how you feel and . . . ”
“I realize this is hard . . . ”
“I see you are busy, and . . . ”
“That must have felt . . . ”
SMILE.
Use humor.
Use nonthreatening body language.
Leave your attitude at the door.
164
Getting Someone to Do What You Want:
DEAR MAN Skills
Remember DEAR MAN:
Describe
Mindful
Express
Appear Confident
Assert
Negotiate
Reinforce
Describe:
Describe the situation. Stick to the facts. “The last three weekends, I
have noticed you coming home after curfew.”
Express:
Express your feelings using “I” statements (“I feel . . . ,” “I would
like . . . ”). Stay away from “you should . . . ”; instead, say, “When you
come home late, I feel worried about you.”
Assert:
Ask for what you want or say “no” clearly. Remember, the other
person cannot read your mind. “I would like you to come home by
curfew.”
Reinforce:
Reward (reinforce) the person ahead of time by explaining the
positive effects of getting what you want. “I would be able to trust
you more and give you more privileges if you stuck to our curfew
agreement.”
Mindful:
Keep your focus on what you want, avoiding distractions. Come back
to your assertion over and over, like a “broken record.” Ignore attacks.
“I know the other kids stay out later than you, and I would still like you
to do your best to meet your curfew.”
Appear
Confident:
Make (and maintain) eye contact. Use a confident tone of voice—do
not whisper, mumble, or give up and say “Whatever.”
Negotiate:
Be willing to GIVE TO GET. Ask for the other person’s input. Offer
alternative solutions to the problem. Know when to “agree to
disagree” and walk away. “If you can do this for the next 2 weeks,
then I will feel comfortable letting you stay out later for the party.”
165
Maintaining Your Self-Respect: FAST Skills
Remember FAST:
(be) Fair
(no) Apologies
Stick to values
(be) Truthful
No thanks;
I’m good!
(be) Fair:
Be fair to yourself and to the other person.
(no) Apologies:
Don’t overapologize for your behavior, for making a request, or for
being you.
(If you wronged someone, don’t underapologize.)
Stick to values:
Stick to your own values and opinions.
Don’t sell out to get what you want, to fit in, or to avoid saying “no.”
(Refer to Emotion Regulation Handout 13, “Wise Mind Values and
Priorities List.”)
(be) Truthful:
Don’t lie.
Don’t act helpless when you are not.
Don’t make up excuses or exaggerate.
Adapted from DBT ® Skills Training Handouts and Worksheets, Second Edition. Copyright 2015 by Marsha M. Linehan. Adapted
by permission.
166
Factors to Consider in Asking for What You Want
(or Saying “No” to an Unwanted Request)
1. Priorities:
Objectives very important? (Is it important to get what I want?)
Relationship shaky? On good terms?
Self-respect on the line?
2. Capability:
Is the person able to give me what I want? (Or do I have what the person
wants?)
3. Timeliness:
Is this a good time to ask? Is the person in the mood to listen or able to
pay attention to me? (Is this a bad time to say “no”?)
4. Preparation:
Do I know all the facts I need to know? Am I clear about what I want?
(Am I clear on the facts that I am using to explain why I am saying “no”?)
5. Relationship:
Is what I want appropriate to the current relationship? (Is what the person
is asking me appropriate to our current relationship?)
6. Give and take:
Has the other person helped me in the past? Have I overused his [her]
help? (Have I helped the other person in the past? Has he [she] overused
my help?)
Which of the above do you need to pay more attention to?
167
Practice Exercise:
Factors to Consider in Asking or Saying “No”
Due Date
Choose a situation during the week in which it was hard to determine whether to ask for
something or to say “no,” or how strong your request or your “no” should be.
Did you consider each of the factors below? Check off which ones applied. If the factor
applied, what was the circumstance, and did considering it lead you to still ask for what you
wanted or say “no” to what someone else wanted? Did it make your request or your “no”
stronger or weaker?
Describe Circumstance
Priorities
Capability
Timeliness
Preparation
Relationship
Give and take
So, what did you decide to do, and how did it work out?
168
Practice Exercise: Using Skills at the Same Time
Due Date
Choose a situation during the week that required more than one interpersonal
effectiveness skill.
Describe situation:
What were my priorities? (Check all that apply.)
Build/maintain relationship
Get what I want, say “no,” or be taken seriously
Build/maintain self-respect
What I said or did and how I did so (check and describe):
Gentle
Describe
Fair
Interested
Express
No apologies
Validate
Assert
Stick to values
Easy manner
Reinforce
Truthful
Mindful
Appear confident
Negotiate
169
THINK Skills
When you want to make peace, reduce conflict, and reduce anger, THINK about it
differently.
We often make interpretations or assumptions about others that fuel our Emotion
Minds and can make the situation worse. So . . .
What’s the situation?
How are your interpretations about the other person fueling your Emotion Mind?
Now try these steps to THINK about it differently:
Think . . .
about it from the other person’s perspective.
Have empathy What might he or she be feeling or thinking?
Interpretations Can you think of more than one possible interpretation or
explanation for the other’s behavior? List other possible reasons
for the behavior; come up with at least one benign reason:
Notice . . .
ways the other person has been trying to make things better, to
help, or to show he or she cares. Or, notice how the other person
may be struggling with his or her own stress or problems.
Use Kindness Can you use kindness and be gentle when you approach the other
person?
170
Overview:
Building Relationships
and Ending Destructive Ones
FINDING AND GETTING PEOPLE TO LIKE YOU
Proximity, similarity, conversation skills,
expressing liking, and joining groups
MINDFULNESS OF OTHERS
Building closeness through mindfulness of others
ENDING DESTRUCTIVE/
INTERFERING RELATIONSHIPS
Staying in WISE MIND
Using skills
Staying safe
171
Finding and Getting People to Like You
REMEMBER: ALL HUMAN BEINGS ARE LOVABLE.
But finding friends may take effort on your part.
LOOK FOR PEOPLE WHO ARE CLOSE BY YOU.
Familiarity often leads to liking and sometimes love.
To find people you might like and who might like you, it is important to make sure that you
are frequently around and visible to a group of people. Many people find friends who are
classmates or members of groups they join, or who work at or go to the same places.
LOOK FOR PEOPLE WHO ARE SIMILAR TO YOU.
We often make friends with people who share our interests and attitudes.
Though always agreeing with someone will not make you more attractive to them, a lot of
people are attracted to those who share the same important interests and attitudes, such as
politics, lifestyle, morals.
WORK ON YOUR CONVERSATION SKILLS.
Ask and respond to questions; respond with a little more info than requested.
Make small talk; don’t underestimate the value of chit-chat.
Self-disclose skillfully; keep your self-disclosure close to that of the other person.
Don’t interrupt; don’t start talking just fractionally before or after someone else.
Learn things to talk about: Watch others; read; increase your activities and experiences.
EXPRESS LIKING (SELECTIVELY).
We often like the people we think like us.
Express genuine liking for the other person. But don’t try to suck up to the other person or
grovel. Find things to compliment that are not super-obvious. Don’t praise too much too often,
and never use compliments to obtain favors.
172
JOIN AN ONGOING GROUP CONVERSATION.
If we wait for people to approach us, we may never have friends.
Sometimes we must make the first move in finding friends. This often requires us to know how
to tell if a group is open or closed, and then, when it is open, how to approach and join in the
ongoing group.
FIGURE OUT IF A GROUP IS OPEN OR CLOSED.
In open groups new members are welcome.
In closed groups new members may not be welcome.
Open Groups
Closed Groups
• Everyone is standing somewhat apart.
• Members occasionally glance around the
room.
• There are gaps in the conversation.
• Members are talking about a topic of
general interest.
• Everyone is standing close together.
• Members attend exclusively to each other.
• There is a very animated conversation with
few gaps.
• Members seem to be pairing off.
FIGURE OUT HOW TO JOIN AN OPEN GROUP CONVERSATION.
Ways of Joining an Open Group
Potential Outcomes
Move gradually closer to the group.
It may not be clear from the slowness of your
approach that you want to join them; it might even
look as though you were creeping up and trying to
eavesdrop!
Offer to refill members’ glasses/
serve them food.
That could be overdoing things a bit. What would you
do if they refused more food/drinks? Would it be clear
enough that you wanted to join the group?
Stand beside them and chip in on
their conversation.
That might seem rude. They haven’t invited you to
join them, and anyway, what exactly are you going to
say when you chip in?
Go up and introduce yourself.
Isn’t that overly formal? Having introduced yourself,
then what do you say? Will they introduce themselves
to you? Wouldn’t you interrupt the conversation?
Wait for a break in the
conversation, stand beside a
friendly-looking member of the
group and say something like
“Mind if I join you?”
This makes your intention clear and doesn’t
seem rude or interrupt the conversation; group
members can then choose whether to introduce
themselves or not.
173
Mindfulness of Others
FRIENDSHIPS LAST LONGER WHEN WE ARE MINDFUL.
OBSERVE
‰‰
Pay attention with interest and curiosity to others around you.
‰‰
Stop multitasking; focus on the people you are with.
‰‰
Stay in the present rather than planning what to say next.
‰‰
Let go of a focus on self, and focus on others around you.
‰‰
Be open to new information about others.
‰‰
Notice judgmental thoughts about others, and let them go.
‰‰
Give up clinging to always being right.
DESCRIBE
‰‰
Replace judgmental words with descriptive words.
‰‰
Avoid assuming or interpreting what other people think about you
without checking the facts. (Remember, no one has ever observed
another person’s thoughts, motives, intentions, feelings, emotions,
desires, or experiences.)
‰‰
Avoid questioning other people’s motives (unless you have very
good reasons to do so).
‰‰
Give others the benefit of the doubt.
PARTICIPATE
‰‰
Throw yourself into interactions with others.
‰‰
Go with the flow, rather than trying to control the flow.
‰‰
Become one with group activities and conversations.
174
Mindfulness of Others
Due Date:
Name:
Week Starting:
Fill out this sheet whenever you practice mindfulness of others and whenever you have an opportunity to practice even if you don’t (or almost don’t) do anything to practice. Write on the back of this
sheet if you need more room.
Check off any of the following that you practiced:
‰‰
Paid attention with interest and curiosity to others around me.
‰‰
Let go of a focus on myself, and focused on the people I was with.
‰‰
Noticed judgmental thoughts about others and let them go.
‰‰
Stayed in the present (instead of planning what I would say next) and listened.
‰‰
Put my entire attention on the other person and did not multitask.
‰‰
Gave up clinging to being right.
‰‰
Other:
‰‰
Described in a matter-of-fact way what I observed.
‰‰
Replaced judgmental descriptions with descriptive words.
‰‰
Described what I observed, instead of making assumptions and interpretations of others.
‰‰
Avoided questioning others’ motives.
‰‰
Other:
‰‰
Threw myself into interactions with others.
‰‰
Went with the flow, rather than trying to control everything.
‰‰
Became one with the conversation I was in.
‰‰
Other:
Describe a situation where you practiced mindfulness of others in the last week.
Who was the person you were with?
How exactly did you practice mindfulness?
What was the outcome?
How did you feel afterward?
Did being mindful make a difference? If so, what?
175
Ending Relationships
A destructive relationship has the quality of destroying or completely spoiling either the quality
of the relationship or aspects of yourself—such as your physical body and safety, your self-esteem
or sense of integrity, your happiness or peace of mind, or your caring for the other person.
An interfering relationship is one that blocks or makes difficult your pursuing goals that are important to you; your ability to enjoy life and do things you like doing; your relationships with other persons; or the welfare of others that you love.
Decide to end relationships in WISE MIND,
NEVER in emotion mind.
If the relationship is IMPORTANT and NOT destructive,
and there is reason to hope it can be improved, try
PROBLEM SOLVING to repair a difficult relationship.
COPE AHEAD to troubleshoot
and practice ending the relationship ahead of time.
Be direct: Use the DEAR MAN GIVE FAST interpersonal
effectiveness skills.
Practice OPPOSITE ACTION FOR LOVE when you find
you love the wrong person.
PRACTICE SAFETY FIRST!
Before leaving a highly abusive or life-threatening
relationship, call a local domestic violence hotline or the
toll-free National Domestic Violence Hotline (1-800-799-7233)
for help with safety planning and a referral to a qualified
professional. See also the International Directory of Domestic
Violence Agencies (www.hotpeachpages.net).
176
Ending Relationships
Due Date:
Name:
Week Starting:
Fill out this sheet to outline how to end an unwanted relationship when the relationship is not abusive. If it is abusive, first call a local domestic violence hotline or the National Domestic Violence Hotline (1-800-799-7233). Write on the back of this sheet if you need more room.
Relationship problem: Describe how the relationship is destructive or interfering with your life.
List Wise Mind pros and cons for ending the relationship.
Pros:
Cons:
Script Ideas for DEAR MAN, GIVE FAST to End a Relationship
1. Describe the relationship situation, or the problem that is the core reason you want to end the
relationship.
2. Express feelings/opinions about why the relationship needs to end for you.
3. Assert in your decision to end the relationship directly (circle the part you will use later in
“broken record” to stay mindful if you need it).
4. Reinforcing comments to make about positive outcomes for both of you once the relationship
is ended.
177
5. Mindful and Appearing confident comments to make about how and when to end (if
needed).
6. Negotiating comments to make, plus turn-the-table comments to avoid getting off track and
responding to insults or diversions (if needed).
7. Validating comments about the other person’s wishes, feelings, or history of the relationship.
8. Easy manner comments.
9. Fair comments.
Check off opposite actions for love you have been doing:
‰‰
1. Reminded myself why love is not justified.
‰‰
2. Did the opposite of loving urges.
‰‰
3. Avoided contact with reminders of loved one.
‰‰
4. Other:
178
Troubleshooting:
When What You Are Doing Isn’t Working
1
Do I have the skills I need? Check out the instructions.
Review what has already been tried.
• Do I know how to be skillful in getting what I want?
• Do I know how to say what I want to say?
• Do I follow the skill instructions to the letter?
Do I know what I really want in this interaction?
Ask:
2
• Am I undecided about what I really want in this interaction?
• Am I unsure of my priorities?
• Am I having trouble balancing:
• Asking for too much versus too little?
• Saying no to everything versus saying yes to everything?
• Is fear or shame getting in the way of knowing what I really want?
3
Are short-term goals getting in the way of long-term goals?
Ask:
• Is “NOW, NOW, NOW” winning out over getting what I really want in the
future?
• Is emotion mind controlling what I say and do instead of WISE MIND?
179
4
Are my emotions getting in the way of using my skills?
Ask:
• Do I get too upset to use my skills?
• Are my emotions so HIGH that I am over my skills breakdown point?
Are worries, assumptions, and myths getting in my way?
Ask:
5
• Are THOUGHTS about bad consequences blocking my action?
“They won’t like me,” “She will think I am stupid.”
• Are THOUGHTS about not deserving things getting in my way?
“I am such a bad person I don’t deserve this.”
• Am I calling myself NAMES that stop me from doing anything?
“I won’t do it right,” “I’ll probably fall apart,” “I’m so stupid.”
• Do I believe MYTHS about interpersonal effectiveness?
“If I make a request, this will show that I am a weak person,”
“Only wimps have values.”
Is the environment more powerful than my skills?
6
Ask:
•
•
•
•
Are the people who have what I want or need more powerful than I am?
Are other people more in control of the situation than I am?
Will others be threatened if I get what I want?
Do others have reasons for not liking me if I get what I want?
Other ideas:
7
180
Troubleshooting Interpersonal Effectiveness Skills
Due Date:
Name:
Week Starting:
Fill out this sheet whenever you practice your interpersonal skills and whenever you have an opportunity to practice, even if you don’t (or almost don’t) do anything to practice. Write on the back of this
sheet if you need more room.
Do I have the skills I need? Check out the instructions.
1
Review what has already been tried.
• Do I know how to be skillful in getting what I want?
• Do I know how to say what I want to say?
• Did I follow the skill instructions to the letter?
‰‰
Not sure:
‰‰
Wrote out what I wanted to say first.
‰‰
Reread the instructions.
‰‰
Got coaching from someone I trust.
‰‰
Practiced with a friend or in front of a mirror.
Did it work the next time? ‰‰Yes (Fabulous) ‰‰No (Continue) ‰‰Didn’t try again
‰‰
Yes:
Do I know what I really want in this interaction?
2
Ask:
• Am I undecided about what I really want in this interaction?
• Am I ambivalent about my priorities?
• Am I having trouble balancing:
• Asking for too much versus not asking for anything?
• Saying no to everything versus giving in to everything?
• Is fear or shame getting in the way of knowing what I really want?
‰‰
Not sure:
‰‰
Did pros and cons to compare different objectives.
‰‰
Used emotion regulation skills to reduce fear and shame.
Did this help? ‰‰Yes (Fabulous) ‰‰No (Continue) ‰‰Didn’t try again
‰‰
Yes:
Are my short-term goals getting in the way of my long-term goals?
3
Ask:
• Is “now, now, now” winning out over getting what I really want?
• Is emotion mind controlling what I say and do instead of Wise Mind?
‰‰
Yes:
‰‰
Did a pros and cons comparing short-term to long-term goals.
‰‰
Waited until another time when I’m not in emotion mind.
Did this help? ‰‰Yes (Fabulous) ‰‰No (Continue) ‰‰Didn’t try again
‰‰
No:
181
Are my emotions getting in the way of using my skills?
4
Ask:
• Do I get too upset to use my skills?
• Are my emotions so high that I am over my skills breakdown point?
‰‰
Yes:
‰‰
Tried TIP skills.
‰‰
Used self-soothing crisis survival skills before the interaction to get myself calm.
‰‰
Did mindfulness of current emotions (Emotion Regulation Handout 22).
‰‰
Refocused attention completely on the present objective.
Did this help? ‰‰Yes (Fabulous) ‰‰No (Continue) ‰‰Didn’t try again
‰‰
No:
Are worries, assumptions, and myths getting in my way?
5
Ask:
• Are thoughts about bad consequences blocking my action?
“They won’t like me,” “She will think I am stupid.”
• Are thoughts about whether I deserve to get what I want in my way?
“I am such a bad person I don’t deserve this.”
• Am I calling myself names that stop me from doing anything?
“I won’t do it right,” “I’ll probably fall apart,” “I’m so stupid.”
• Am I believing myths about interpersonal effectiveness?
“If I make a request, this will show that I am a very weak person,” “Only wimps have values.”
‰‰
Yes:
‰‰
Challenged myths.
‰‰
Checked the facts.
‰‰
Did opposite action all the way.
Did this help? ‰‰Yes (Fabulous) ‰‰No (Continue) ‰‰Didn’t try again
‰‰
No:
Is the environment more powerful than my skills?
6
Ask:
• Are the people who have what I want or need more powerful than I am?
• Are the people commanding me powerful and in control?
• Will others be threatened if I get what I want?
• Do others have reasons for not liking me if I get what I want?
‰‰
Yes:
‰‰
Tried problem solving.
‰‰
Found a powerful ally.
‰‰
Practiced radical acceptance.
Did this help? ‰‰Yes (Fabulous) ‰‰No (Continue) ‰‰Didn’t try again
‰‰
No:
182
"EEFOEVN4FDUJPO
4UVGGXFGPSHPUPSGPVOEMBUFS
183
Encouraging Affirmations
I accept myself as I AM, always and in all ways.
I know and accept that all things presented to me are divine gifts of unconditional love.
I accept all others as individual expressions of divine love.
I AM perfect in the eyes of my Creator; therefore, I choose to see perfection in all things and all events
All life is an expression of divine love. I now choose to accept that all things on Earth are equal and worthy of my love
and attention.
I AM a perfect expression of love, and I express my love unconditionally to all others and myself.
I offer the gifts of love and compassion without asking or expecting anything in return.
I AM now able to find the humor in my ‘mistakes,’ for I see that these are perfect and divine lessons being presented
to me.
I AM without judgment of others or myself. I unconditionally accept that all things are on expression of divine love.
I accept, unconditionally, that I create my reality through my thoughts, words, and actions. I now think only loving
thoughts. I now say only loving words. I now act only lovingly toward all others and myself.
I choose to love myself, and I see love’s perfection reflected in everything and everyone.
I love, honor, and accept the perfection of Spirit within myself and within all things.
I now choose to recognize the love and perfection in all things and in all events.
I now accept that I am only Love in its most divine expression.
I AM loving and compassionate toward all others, regardless of any situation.
I AM never a victim of circumstance. All lessons presented to me are perfect, and I gratefully accept them as part of
my soul’s growth.
Today, I choose to place love around any fear-based emotions I may have toward another person or situation.
I choose to unconditionally accept my family, my friends, my peers, all who I encounter today regardless of the
circumstances and myself.
Today, I chose to accept the world, its people and its events as they are, without judgment or fear.
I AM aware that I create my reality; therefore, I now choose to accept everyone and everything, without conditions
attached. In this way, I create a new reality—one of love and peace.
At the core of all things in the universe, there is only divine love. I choose to see only the divine love in everyone.
Anything other than love is an illusion.
My role as a human being is to recognize my divinity, to unconditionally accept my divinity and to be this divinity at all
times.
I am aware that I am my own soul mate. My relationship with myself is reflected in all that I experience.
By my practicing unconditional acceptance of myself, I AM now able to accept all others as they are.
I now choose to invite joy, laughter, peace, and love into my life, and I accept these gifts in whatever form they are
presented to me.
I show the way to others by choosing unconditional love and acceptance in any situation.
My unconditional love and acceptance of who I AM, lights my pathway home.
I AM free of judgment and I AM now filled with unconditional love and acceptance for all things.
Be like a postage stamp. Stick one things until you get there.
Though no one can go back and make a new start, anyone can start from now and make a brand new end.
Never give up for that is just the time and place the tide will turn.
If I have inside of me the stuff to make cocoons, then maybe the stuff to make butterflies is there, too.
To be upset over what I don’t have to waste what I do have.
I hang onto my humor. I don’t ask for permission, I just do it. I make everything fun!
184
Today I will seek out things that are fun to do.
I am curious, eager to try new things.
I experience and express my emotions freely.
I am creative and innovative.
I rest when my body tells me to.
I learn enthusiastically.
This is a new and wonderful day for me; there will never be another day like this.
Whenever my attention wanders away from that which is good and constructive, I immediately bring it back to the
contemplation of that which is lovely and of good report.
I am going to be a wonderful success in all my undertakings today.
I am definitely going to be happy all day long!
I am not afraid of life. I believe that life is worth living, and my belief helps create the fact.
Either I find a way, or I will make one.
It doesn’t matter what the struggle is. There is always room for hope. I am not going to die one of the statistics.
The question I ask myself is not if I should heal but how I should heal.
I will not wait to have a good day. I will make one.
I move beyond my old limitations and allow myself to express freely and creatively.
Life is about change, and I adapt easily to the new.
I forgive myself and others, release the past and move forward with love in my heart.
I love and approve of myself, am at peace with my own feelings and stand tall and free.
If I can endure for this minute whatever is happening to me, no matter how heavy my heart is, or how dark the
moment might be. If I can but keep on believing what I know in my heart to be true, that darkness will fade with
morning and this will pass away, too. Then nothing can ever disturb me or fill me with uncertain fear. For as sure as
night brings dawning, my morning is bound to appear.
I will persist until I succeed.
I can go the extra mile today.
I will dwell on the positive affirmations and things in my life, and they will become my aspiration.
My free time can be used creatively, inventively, and imaginatively. I do not need to use it for routine habits, which
are unimportant and unhealthy.
I will be patient in steadily working toward my goal, remembering that all good comes in time.
I will hold on. I will be brave. I am almost there. I will never give up.
Walking away from something that is bad for me is not quitting!
I have learned to treat myself gently because with a few exceptions, I am doing my best.
I will not feel guilty for caring for myself.
I will not be hard on myself today.
I will not be embarrassed by my pain. I will go through it with dignity. It will enhance me.
I am grateful for who I am.
I will accept my pain when it is present. I will NOT anticipate it.
I will be more understanding of the needs of others when I am able to care for my own.
I will resist anything that takes me off the chosen path of recovery.
Loving life increases my energy and passions.
When I am in trouble, dwelling on it doesn’t really help. I can feel sad, I can grieve, but eventually I have to move on.
Time does heal, and when I am going through a difficult patch I will remember I don’t want to make it any worse.
When I put force and energy behind something, the results are powerful.
If I break my habits and shake up my day a bit, I will gain new impressions and understanding.
The more things I plan to do, the more energy I will have.
185
I am in charge. I am responsible for the direction of my boat.
I will forgive in order to move forward.
No one can make me a victim unless I allow them to.
Anger hurts more than the person I feel rage toward. I will let go and move on. Life is too valuable to get stuck.
I am naturally beautiful when I am myself.
All that we are is a result of what we have thought.
I will not let others interfere with my steady resolve to live a full, useful, and productive day.
Focusing on the present moment will make me less anxious.
I am meant to be very different from everyone else. This releases the burden of feeling like I have to be someone
other than me.
Today is the beginning of the rest of my life. It is a clean slate. I will begin it totally refreshed and just live it.
I carry within me all the essentials of a happy existence.
My task is to do the best I can which is enough!
I gain energy from doing those things I choose to do rather than what I feel I have to do.
When I put my time to good use, I value myself and feel good.
If I expect recovery to be easy, I will become frustrated. The easy stuff doesn’t teach us much what is difficult and
challenging enhances my growth.
I will be proud of my strengths and nurture them.
No one else can blame me and make me feel wrong unless I accept the accusations and choose to feel the guilt.
What I do today may have a profound impact on my life tomorrow. I will be the best person I can be today.
A quiet and pleased mind absorbs beauty and grace naturally. I will relax, be calm, and therefore be content.
When I do a good job in whatever challenges there are, I am living.
It is comforting to know I have all the necessary muscles to cope when faced with really difficult times.
Whenever I face a hardship, feel anxious, nervous, and sad, I will embrace my pain and agony. I know I can learn from
my misery and pain and share the knowledge with others.
I will surround myself with people who are affirming and encouraging.
I will choose what is really important to me before I run out of time.
Remaining optimistic will help me experience joy.
I will go about my life doing what I believe is right and hold fast to my beliefs.
I appreciate and am grateful for all the help I get along the way as I try to stay on course.
I choose to make the best of what I have, I am brave, I will survive.
I have faith in family friends and myself. I have faith in this world.
I have faith in my process of recovery.
I will look for the beauty in every problem I have to solve.
Thoughts provoke action. I will think healthy thoughts to provide healthier actions.
When I am faced with a difficult time, I will get through it better by focusing on what I hope to accomplish. I will be
strong, do what I have to do and move forward.
I do the very best I know how, the very best I can.
Wherever I am I will do my best and that is all I will ever expect of myself.
I will live my life in the way I want to be remembered.
I will surround myself with trustworthy people and put my trust in them.
When I am required to exhibit strength, it comes.
Negative thoughts will NEVER help; they will ALWAYS hurt me.
I am not in control of others, but I am in control of myself.
When I am content to simply be myself and don’t compare or compete, everybody will respect me.
I will never please everyone and that’s okay.
186
I will not listen to anyone who tells me what I can’t do.
I am proud of myself for all I have accomplished no matter how small or great.
I regret nothing, because I am and do the best I can.
I will not let the lessons or experiences of the past dampen my enthusiasm for new beginnings.
I will go where my heart leads.
I will trust my soul—it knows the way.
I will see myself doing all the things I would like to do. I will take the time to use my creative power of visualization to
create the life I would like. Above all I will take the time to see myself being happy.
I will trust, honor, and respect the process of change.
I can listen to my needs.
Taking time to honor the needs of my body is taking time to respect the needs of my soul.
I can get out of my rut and discover what interests me.
I will do what I need to break through my resistance.
See how powerful I am!
I will seek out people who empower me. And during those times when they are not around, I will know that I can
empower myself.
When I look back at my past I will look tenderly and gently at all I have been through. I will be proud of my
accomplishments and how far I have come.
One step at a time. That is how I will get where I am going.
I will take the time to honor and express my dreams.
I am free to redefine and help create the life I choose.
I am free to see life in a new way.
I can open myself to the hopes and dreams of today.
I am ready to heal my heart. I am deserving of this.
I am powerful now and powerfully connected to myself.
There is a purpose and value to each day of my life. I will nurture my times of action of creating of doing and value my
quieter times of going within.
I have all the guidance, energy, ideas, creativity, power, and ability to do all I am meant to do. I will be given the
power to enjoy it.
I will make each moment count today.
Give yourself some relief. Take the pressure off.
Today I take time to inhale peace and exhale fear.
Facing and feeling my fears will empower me to move on.
I am doing better than I think.
Reward yourself often. When you accomplish a particular task. When you have gone through a grueling part of your
healing process. Reward yourself during the frustrating times just for being patient. Sometimes, reward yourself for
just being you.
Many things are possible if I accept the fastest way is one step at a time.
When I feel too much stress, I will give myself a break and let my body start soaking up some healing energy.
I will not let expectations distort my experience.
I believe I deserve love.
I am not afraid of making mistakes.
I can embrace the mystery and magic of myself.
I can stop punishing myself with fear.
I will not allow the fear of “what if” to ruin the joy of “what is.”
I can let go of the need to prove myself to others.
187
I will be gentle with myself when I get stuck.
I do not need to be paranoid and have to think every event means something.
I trust the timing of my lessons.
Self-Love is my birthright.
Every choice I make will teach me something and whenever I learn something there is success, not failure.
I am making the healthiest, most loving choices. I am capable of making at this very moment.
I can weather the storms and let them pass.
I can let go of shame.
I can recognize the desire in my heart to recover.
I am grateful to the people who are helping me heal, grow, and move along my path.
I am free to be all I can be.
I deserve to recover.
Sometimes I need to spin our wheels. It helps me get unstuck.
I can allow myself to heal. I can find new messages that empower me with love, messages that set me free.
No matter what I am going through, my soul can be at peace.
Maybe I am where I am today for a reason other than I thought. Maybe the first thing to do is cleanse the past and
heal my heart.
I have the power to create joy by choosing what feels good for me.
I will be gentle with myself. I am not alone in my problem, my powerlessness, or my search for solution.
I can learn to embrace change.
I will let myself receive the healing I need.
For now, I will trust and experience what I am going through. I know that this time of change is sacred.
I will let my choices come from my heart.
I trust that the waiting part of change is necessary. I trust my desire for change is the beginning of change. I trust that
each moment I am moving closer to the change I desire.
We will be given the power to do all we need to do. Take the simple steps that lie before you. Take one step at a time.
You will find the way again.
I will not try to complicate things or try to figure it all out. The answer is simple. I will look into my heart.
I will reduce as much toxicity in my environment and in myself as I can.
I will embrace the changes taking place in me now. They are good.
I will be clear and forthright about what I need and want.
I have faith that wherever I am going is important and wonderful.
I can use the potent, creative power of visualization to create pictures of all the good I would like to see in my life.
If I feel an emotion—an old, stuck, hardened chunk of emotion or a new one that has arisen along the way—I can
release it and the belief attached to it.
How overwhelmed we feel when we anticipate the future, all that needs doing, all the tasks, the work, the potential
problems, the responsibilities. I will stay in the present moment, and the past and future will fall naturally and easily
into place.
All the wonders I seek are within me.
I am the first person who needs to like me.
I can become the person I want to be.
I make the world more special just by being in it.
I believe life is worth living.
I can sit down in a quiet place and get in touch with myself.
I will make an effort every day to feel good about who I am and what I can be.
Today I will work on improving my abilities rather than my disabilities.
188
I run my own life.
I am okay.
I can live in peace at a time of stress.
I cannot climb uphill by thinking downhill thoughts.
I can move away from self-defeating beliefs.
I have choices. I can choose new responses to old situations. I can learn to recognize my true needs and choose
positive ways of satisfying them.
Understanding and respecting my limits, I can learn to say no to what might jeopardize my serenity and wellbeing.
I need care and attention. I am responsible for seeing that this need is met.
I will give myself the care and attention I need.
The beginning I make today is never insignificant or unimportant. It is the foundation of my future.
I now have the opportunity to pursue my desires until I discover what brings me happiness.
Freedom from my addiction clears away the depression and passivity that prevents me from identifying and going
after my deepest heart’s desire.
I am free to do and enjoy the good things that come my way, and I am equipped to deal with inevitable problems.
If I begin to get bored with the mechanics of my program, I need to remember what it was like before.
I grow by doing what’s hard to do.
I will accept today’s challenges to grow.
I no longer need to spend large blocks of time obsessing.
I have the wisdom to know how I want to spend my time and energy today.
I cannot control or change others, but I can change myself.
Today I can take a small risk in the interest of enriching my life.
I will determine my priorities today to avoid confusion.
I can choose to have a daily reprieve from self-destructive behavior.
I will seek progress, not perfection.
If I let myself down by slipping back into old habits, I can gently correct my course without feeling that I have failed.
Today, I will concentrate on taking one step forward, however small.
Today, I will seek renewed supply of serenity, courage, and wisdom.
I have much to give. I can be loved and accepted according to how well I give of myself, not for how much.
Whatever my struggle today, I am a worthwhile person with valuable contributions to make to those around me.
I am not finished growing, changing, and evolving.
I like myself today. I am aware of possibilities for improvement, but I don’t want to be anyone else. I am comfortable
and accepting of who I am. I can forgive my mistakes and move on to try again.
Today I am glad to be ME!
Positive or negative…the choice is mine!
My actions today will build good memories for tomorrow.
I cannot see the outcome of the journey, but I can take the next step.
I have the will, strength, and desire to continue working on recovery.
189
Treatment
Implementation
Collaborative
Disseminating Evidence Based Practices
Across the Continuum of Care
www.ticllc.org
DBT House of Treatment Handout
Adapted from M. Linehan - Stages of Treatment :: Created by Charles Swenson, M.D. 2012
190
Page 1 of 1
Step One
We admitted that we were powerless over our addiction, that our lives
had become unmanageable.
*Admitted that when we participate in drinking, drugging and acting out
behavior that our lives get out of control.
Step Two
Came to believe that a power greater than ourselves could restore us to
sanity.
*Came to believe that we could change with the help of others.
Step Three
Made a decision to turn our will and our lives over to the care of God as
we understood Him.
*Made a decision to work with others to make changes in our behavior
and our value system.
Wise Mind
What Skills (Observe, Describe, Participate)
How Skills (Nonjudgmental, One Mindfully, Effectiveness)
FAST
Pros and Cons
Radical Acceptance
Values and Priorities (Building a Life Worth Living) (DBT-SUD)
Cheerleading Statements
Wise Mind
What Skills (Observe, Describe, Participate)
How Skills (Nonjudgmental, One Mindfully, Effectiveness)
Values and Priorities (Building a Life Worth Living) (DBT-SUD)
Willingness versus Willfulness
IMPROVE the Moment
Observing Your Breath
Wise Mind
What Skills (Observe, Describe, Participate)
How Skills (Nonjudgmental, One Mindfully, Effectiveness)
FAST
Values and Priorities (Building a Life Worth Living) (DBT-SUD)
Willingness versus Willfulness
Turning the Mind
Burning Your Bridges (DBT-SUD)
Let Go of Emotional Suffering
Cheerleading Statements
Avoiding and Eliminating the Cues to Use (DBT-SUD)
191
Step Four
Made a searching and fearless moral inventory of ourselves.
*Made a list of behaviors we need to change and recognized the positive
strengths that will help us make these changes.
Step Five
Admitted to God, to ourselves, and to another human being the exact
nature of our wrongs.
*Shared our list with another person.
Step Six
We were entirely ready to have God remove all these defects of
character.
*Were ready to leave these old behaviors, attitudes and values behind.
Step Seven
Humbly asked Him to remove our shortcomings.
*Became willing to work with others to change these old behaviors,
attitudes and values.
Nonjudgmental Stance
Observe and Describe
Values and Priorities (Building a Life Worth Living) (DBT-SUD)
Radical Acceptance
FAST
Willingness versus Willfulness
Wise Mind
Identifying and Labeling Emotions
Urge Surfing (DBT-SUD)
Wise Mind
What Skills (Observe, Describe, Participate)
How Skills (Nonjudgmental, One Mindfully, Effectiveness)
Values and Priorities (Building a Life Worth Living) (DBT-SUD)
Radical Acceptance
Willingness versus Willfulness
DEAR MAN
GIVE
FAST
Wise Mind
Willingness versus Willfulness
Turning the Mind
Burning Your Bridges
Avoiding and Eliminating the Cues to Use (DBT-SUD)
Wise Mind
What Skills (Observe, Describe, Participate)
DEAR MAN
FAST
Effectiveness
192
Step Eight
Made a list of all the persons we had harmed, and became willing to
make amends to them all.
*Made a list of people, including myself, who have been hurt by our
behavior and decided to make amends to them.
Step Nine
Made direct amends to such people wherever possible, except when to do
so would injure them or others.
*Took responsibility for our behavior and for forgiving ourselves by
making amends to people who have been hurt by our behavior.
Step Ten
Continued to take personal inventory and when we were wrong promptly
admitted it.
*Continue to take responsibility for ourselves and admit when we are
wrong.
Wise Mind
What Skills (Observe, Describe, Participate)
How Skills (Nonjudgmental, One Mindfully, Effectiveness)
Willingness versus Willfulness
Cheerleading Statements
FAST
Building a Life Worth Living (DBT-SUD)
Wise Mind
DEAR MAN
GIVE
FAST
Attend to Relationships (Building a Life Worth Living) (DBT-SUD)
Cheerleading Statements
Alternate Rebellion (DBT-SUD)
Half Smile
IMPROVE the moment
Opposite to Emotion Action
Wise Mind
Nonjudgmental Stance
Observe and Describe
ABC PLEASE
FAST
Turning the Mind
Willingness versus Willfulness
Urge Surfing (DBT-SUD)
Opposite to Emotion Action (for changing Shame)
Alternate Rebellion (DBT-SUD)
Adaptive Denial (DBT-SUD)
193
Step Eleven
Sought through prayer and meditation to improve our conscious contact
with God, as we understood Him, praying only for the knowledge of His
will for us and the power to carry that out.
*Tried, with the help of others, to be a better person—someone we can
be proud of and live with.
Step Twelve
Having had a spiritual awakening as the result of these steps, we tried to
carry this message to addicts who still suffer, and to practice these
principles in all our affairs.
*Having been able to change our lives with the help of others, we offer
our help to others.
Wise Mind
What Skills (Observe, Describe, Participate)
How Skills (Nonjudgmental, One Mindfully, Effectiveness)
Self-Sooth
IMPROVE the Moment
Observing Your Breath
ABC PLEASE
Willingness not Willfulness
FAST
Building a Life Worth Living (DBT-SUD)
Wise Mind
What Skills (Observe, Describe, Participate)
How Skills (Nonjudgmental, One Mindfully, Effectiveness)
DEAR MAN
GIVE
FAST
Building a Life Worth Living (DBT-SUD)
194
The Serenity Prayer
God, grant me the serenity to radically accept the things I cannot
change, the courage to change the things I can, and the wisdom to
know the difference.
“One Day At A Time”
Not using just for today. Focusing on today’s responsibilities.
H.A.L.T.
Don’t let yourself get too Hungry, Angry, Lonely or Tired.
Wise Mind
Radical Acceptance
Increasing Positive Emotions
Wise Mind ACCEPTS
ABC PLEASE
Willingness versus Willfulness
FAST
Urge Surfing (DBT-SUD)
Wise Mind
One Mindfully
Effectiveness
Radical Acceptance
Turning the Mind
Willingness versus Willfulness
Alternate Rebellion (DBT-SUD)
Adaptive Denial (DBT-SUD)
Urge Surfing (DBT-SUD)
Wise Mind ACCEPTS
IMPROVE the Moment
Self-Sooth
Pros and Cons
ABC PLEASE
Opposite to Emotion Action
Wise Mind
ABC PLEASE
Opposite to Emotion Action (for Anger
Building a Life Worth Living (DBT-SUD)
195